Invasive functional assessment of the severity of coronary lesions during surgical myocardial revascularization: background and prospects

• Karen V. Petrosian
• Aslanbek V. Karaev

Abstract

The aim of this review is to discuss the prospects for the use of methods for invasive functional assessment of the severity of coronary heart disease (CHD) in patients who are indicated for myocardial revascularization – coronary artery bypass grafting (CABG).

National clinical guidelines for the treatment of stable coronary artery disease (CR of the Ministry of Health of Russia, 2020) determine the feasibility of using the method of measuring fractional blood flow reserve (FFR) to assess the hemodynamic significance of coronary lesions when determining indications for myocardial re vascularization (PCI or CABG) only in the case of ambiguous indications for invasive coronary angiography (not absolute indications for surgery). The decision on the appropriateness of coronary artery bypass grafting is usually based on the anatomical assessment of the severity of stenosis using selective coronary angiography, while data on the role of invasive functional assessment in performing surgical revascularization in real clinical practice is limited.

In early studies on the use of FFR and the method of assessing the instantaneous or diastolic blood flow reserve (IFR), patients with absolute indications for myocardial revascularization were more often excluded. At the same time, based on current world literature data, the use of methods for measuring FFR and IFR when planning a CABG operation and determining the scope of intervention may play an important role in stratifying the risk of developing dysfunction of various conduits in the early and long-term period.

Keywords:instantaneous flow reserve; fractional flow reserve; ischemic heart disease; coronary artery bypass grafting; percutaneous coronary intervention

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