Feasibility of planning coronary artery bypass grafting based only on coronary computed tomography angiography and CT-derived fractional flow reserve: a pilot survey of the surgeons involved in the randomized SYNTAX III Revolution trial

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Sonck, Jeroen ^{[1, 2]} ; Miyazaki, Yosuke ^[3] ; Collet, Carlos ^{[4, 1]} ; Onuma, Yoshinobu ^{[3, 5]} ; Asano, Taku ^[4] ; Takahashi, Kuniaki ^[4] ; Kogame, Norihiro ^[4] ; Katagiri, Yuki ^[4] ; Modolo, Rodrigo ^[4] ; Serruys, Patrick W. ^{[6, 5]} ; Bartorelli, Antonio L. ^{[7, 8]} ; Andreini, Daniele ^{[9, 8]} ; Doenst, Torsten ^[10] ; Maureira, Juan Pablo ^[11] ; Plass, Andre ^[12] ; La Meir, Mark ^[1] ; Pompillio, Giulio ^{[9, 8]}

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^[1] Univ Ziekenhuis Brussel, Dept Cardiol & Cardiovasc Surg, Brussels - Belgium

^[2] Univ Naples Federico II, Dept Adv Biomed Sci, Naples - Italy

^[3] Erasmus Univ, Med Ctr, Thoraxctr, Dept Intervent Cardiol, Rotterdam - Netherlands

^[4] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Amsterdam - Netherlands

^[5] Cardialysis BV, Rotterdam - Netherlands

^[6] Imperial Coll London, Dept Cardiol, London - England

^[7] Univ Milan, Dept Biomed & Clin Sci Luigi Sacco, Milan - Italy

^[8] IRCCS, Ctr Cardiol Monzino, Milan - Italy

^[9] Univ Milan, Dept Clin Sci & Community Hlth, Milan - Italy

^[10] Friedrich Schiller Univ Jena, Jena Univ Hosp, Dept Cardiothorac Surg, Jena - Germany

^[11] CHRU Nancy, Dept Cardiovasc Surg, Nancy - France

^[12] Univ Hosp Zurich, Div Cardiovasc Surg, Zurich - Switzerland

• Tipo de documento: Artigo Científico
• Fonte: Interactive Cardiovascular and Thoracic Surgery; v. 29, n. 2, p. 209-216, AUG 2019.
• Citações Web of Science: 0

Resumo

OBJECTIVES: Invasive coronary angiography has been the preferred diagnostic method to guide the decision-making process between coronary artery bypass grafting (CABG) and percutaneous coronary intervention and plan a surgical revascularization procedure. Guidelines recommend a heart team approach and assessment of coronary artery disease (CAD) complexity, objectively quantified by the anatomical SYNTAX score. Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFRCT) are emerging technologies in the diagnosis of stable CAD. In this study, data from patients with left main or 3-vessel CAD who underwent CABG were evaluated to assess the feasibility of developing a surgical plan based on CCTA integrated with FFRCT. The primary objective was to assess the theoretical feasibility of surgical decision-making and treatment planning based only on non-invasive imaging. METHODS: This study represents a survey of surgeons involved in the SYNTAX III Revolution trial. In this trial, heart teams were randomized to make treatment decisions using CTA. CCTAs and FFRCT results of 20 patients were presented to 5 cardiac surgeons. RESULTS: Surgical treatment decision-making based on CCTA with FFRCT was considered feasible by a panel of surgeons in 84% of the cases with an excellent agreement on the number of anastomoses to be made in each patient (intraclass correlation coefficient 0.77, 95% confidence interval 0.35-0.96). CONCLUSIONS: Using non-invasive imaging only in patients with left main or 3-vessel CAD, an excellent agreement on treatment planning and the number of anastomoses was found among cardiac surgeons. Thus, CABG planning based on non-invasive imaging appears feasible. Further investigation is warranted to determine the safety and feasibility in clinical practice. (AU)

• Processo FAPESP: 17/22013-8 - Impacto da complexidade coronariana sobre a mortalidade e eventos cardiovasculares de pacientes com infarto agudo do miocárdio em diferentes regimes de tratamento antiplaquetário
• Beneficiário: Rodrigo Gimenez Pissutti Modolo
• Modalidade de apoio: Bolsas no Exterior - Pesquisa