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Pellicano, M; De Bruyne, B; Toth, GG; Casselman, F; Wijns, W; Barbato, E.
Fractional flow reserve to guide and to assess coronary artery bypass grafting.
Eur Heart J. 2017; 38(25):1959-1968 Doi: 10.1093/eurheartj/ehw505 [OPEN ACCESS]
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Toth-Gayor Gabor

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The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email:
Find related publications in this database (using NLM MeSH Indexing)
Coronary Artery Bypass - methods
Coronary Artery Disease - complications
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Coronary Occlusion - complications
Coronary Occlusion - physiopathology
Coronary Occlusion - surgery
Coronary Stenosis - complications
Coronary Stenosis - physiopathology
Coronary Stenosis - surgery
Fractional Flow Reserve, Myocardial - physiology
Heart Valve Diseases - complications
Heart Valve Diseases - physiopathology
Heart Valve Diseases - surgery
Humans -
Myocardial Revascularization - methods
Percutaneous Coronary Intervention - methods

Find related publications in this database (Keywords)
Fractional flow reserve
Coronary artery bypass graft
Multivessel disease
Left main coronary disease
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