超越数字:在经历CABG的多血管疾病中以FFR为指导的策略的挑战 - 想象不同
Francesco Ferraro1, Tristan Ehrlich1, Juliette Piccoli1
1Department of Cardiovascular Surgery and Heart Transplantation, University Hospital of Nancy-Brabois, Rue de Morvan, Vandoeuvre-lès-Nancy 54000, France.
European heart journal. Case reports
|November 5, 2025
概括
部分流量储备 (FFR) 在冠状动脉旁路移植 (CABG) 中的使用是不确定的. 这一案例突出了FFR在手术规划中的局限性,强调其作为辅助的作用,而不是指令,以获得最佳的心肌保护.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 生理学评估 生理学评估
背景情况:
- 分流储备 (FFR) 已建立,用于指导中等冠状动脉病变的皮肤穿冠状动脉干预 (PCI).
- 它在冠状动脉旁路移植 (CABG) 中的作用缺乏经过验证的值和标准化的手术规划整合.
- 目前的指导方针并不完全支持在CABG决策中使用FFR.
研究的目的:
- 为了说明在CABG中应用PCI衍生的FFR值的局限性.
- 强调需要在外科重血管化中采取超越FFR的综合方法.
- 倡导FFR作为生理辅助而不是CABG的最终指南.
主要方法:
- 病例报告:一名69岁的男性患有三血管冠状动脉疾病,正在接受全动脉再血管化.
- 在手术前对左前下降动脉 (LAD) 的FFR评估.
- 内部操作的过渡时间流量测量和移植修订.
- 随访3个月,进行血管造影和心肌输液成像.
主要成果:
- 在手术前LAD的FFR为0.78,表明有显著的病变.
- 术内流量测量显示了严重受损的移植流量,需要修复解剖.
- 复查后和3个月的随访血管造影显示了移植失败.
- 3个月后的心肌输液成像显示,尽管移植失败,但在LAD区域没有显著的缺血.
结论:
- 在CABG中应用基于PCI的FFR值可能会导致不适当的策略和早期的移植失败.
- FFR应该是辅助的,与临床,解剖学和手术内评估相结合,而不是唯一的决定因素.
- 未来的试验和多学科专业知识是必要的,以便在CABG规划中微妙地整合FFR.
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