Totally arterialized minimally invasive coronary artery bypass grafting under the guidance of coronary artery function: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHUANG Dongsi , FU Jun , WANG Jiangyou , YU Chunjun ,  HUA Zhengdong

1. Department of Cardiovascular Internal and Surgical Medicine, Wuhan Asia Heart General Hospital, Wuhan, 430022, P. R. China;

Corresponding author：

HUA Zhengdong, Email: sds97@163.com

Keywords：

Exertional angina pectoris; totally arterialized minimally invasive coronary artery bypass grafting; quantitative flow ration; computed tomography fractional flow reserve; case report

DOI：

10.7507/1007-4848.202208004

Video：

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Abstract Full text Figures/Tables Video References Cited by

We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.

Citation： SHUANG Dongsi, FU Jun, WANG Jiangyou, YU Chunjun, HUA Zhengdong. Totally arterialized minimally invasive coronary artery bypass grafting under the guidance of coronary artery function: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 634-638. doi: 10.7507/1007-4848.202208004 Copy

1.	Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery: Insights from PREVENT Ⅳ. Circulation, 2014, 130(17): 1445-1451.
2.	Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
3.	Kalyanasundaram A, Berger P. Fractional flow reserve-guided PCI reduced major adverse cardiac outcomes compared with angiography-guided PCI in multivessel CAD. Ann Intern Med, 2009, 150(10): JC5-JC7.
4.	Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol, 2017, 70(25): 3077-3087.
5.	Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: The FAVOR Ⅱ Europe-Japan study. J Am Heart Assoc, 2018, 7(14): e009603.
6.	Miyata K, Asano T, Saito A, et al. Heart Team risk assessment with angiography-derived fractional flow reserve determining the optimal revascularization strategy in patients with multivessel disease: Trial design and rationale for the DECISION QFR randomized trial. Clin Cardiol, 2022, 45(6): 605-613.
7.	李永兴, 刘宝堂, 侯文明. 冠状动脉旁路移植术序贯和单支吻合研究进展. 心脏杂志, 2020, 32(5): 534-536, 542.
8.	朱云鹏, 朱嘉希, 张嵬, 等. 定量血流分数指导冠状动脉外科血运重建的研究. 上海交通大学学报 (医学版), 2020, 40(7): 936-942.
9.	Tao Y, Gao Y, Wu X, et al. Diagnostic performance of coronary computed tomography (CT) angiography derived fractional flow reserve (CTFFR) in patients with coronary artery calcification: Insights from multi-center experiments in China. Ann Transl Med, 2022, 10(14): 788.
10.	Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol, 2011, 58(19): 1989-1997.
11.	Nørgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (analysis of coronary blood flow using CT angiography: Next steps). J Am Coll Cardiol, 2014, 63(12): 1145-1155.
12.	Farooq V, Girasis C, Magro M, et al. The CABG SYNTAX score: An angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery: From the SYNTAX left main angiographic (SYNTAX-LE MANS) substudy. EuroIntervention, 2013, 8(11): 1277-1285.
13.	Farooq V, Girasis C, Magro M, et al. The coronary artery bypass graft SYNTAX Score: Five year outcomes from the SYNTAX-LE MANS left main angiographic sub-study. EuroIntervention, 2013, 9(8): 1009-1010.
14.	Papadopoulou SL, Girasis C, Dharampal A, et al. CT-SYNTAX score: A feasibility and reproducibility Study. JACC Cardiovasc Imaging, 2013, 6(3): 413-415.

1. Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery: Insights from PREVENT Ⅳ. Circulation, 2014, 130(17): 1445-1451.
2. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
3. Kalyanasundaram A, Berger P. Fractional flow reserve-guided PCI reduced major adverse cardiac outcomes compared with angiography-guided PCI in multivessel CAD. Ann Intern Med, 2009, 150(10): JC5-JC7.
4. Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol, 2017, 70(25): 3077-3087.
5. Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: The FAVOR Ⅱ Europe-Japan study. J Am Heart Assoc, 2018, 7(14): e009603.
6. Miyata K, Asano T, Saito A, et al. Heart Team risk assessment with angiography-derived fractional flow reserve determining the optimal revascularization strategy in patients with multivessel disease: Trial design and rationale for the DECISION QFR randomized trial. Clin Cardiol, 2022, 45(6): 605-613.
7. 李永兴, 刘宝堂, 侯文明. 冠状动脉旁路移植术序贯和单支吻合研究进展. 心脏杂志, 2020, 32(5): 534-536, 542.
8. 朱云鹏, 朱嘉希, 张嵬, 等. 定量血流分数指导冠状动脉外科血运重建的研究. 上海交通大学学报 (医学版), 2020, 40(7): 936-942.
9. Tao Y, Gao Y, Wu X, et al. Diagnostic performance of coronary computed tomography (CT) angiography derived fractional flow reserve (CTFFR) in patients with coronary artery calcification: Insights from multi-center experiments in China. Ann Transl Med, 2022, 10(14): 788.
10. Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol, 2011, 58(19): 1989-1997.
11. Nørgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (analysis of coronary blood flow using CT angiography: Next steps). J Am Coll Cardiol, 2014, 63(12): 1145-1155.
12. Farooq V, Girasis C, Magro M, et al. The CABG SYNTAX score: An angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery: From the SYNTAX left main angiographic (SYNTAX-LE MANS) substudy. EuroIntervention, 2013, 8(11): 1277-1285.
13. Farooq V, Girasis C, Magro M, et al. The coronary artery bypass graft SYNTAX Score: Five year outcomes from the SYNTAX-LE MANS left main angiographic sub-study. EuroIntervention, 2013, 9(8): 1009-1010.
14. Papadopoulou SL, Girasis C, Dharampal A, et al. CT-SYNTAX score: A feasibility and reproducibility Study. JACC Cardiovasc Imaging, 2013, 6(3): 413-415.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Totally arterialized minimally invasive coronary artery bypass grafting under the guidance of coronary artery function: A case report

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