Kim Min-Seok, Ryu Ah-Jin, Kim Jung Won, Lee Cheol Ho, Hwang Seong Wook, Kim Ki-Bong
Cardiovascular Center, Myongji Hospital, Gyeonggido, Republic of Korea.
AiMEDiC, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2025 Aug 30. doi: 10.1016/j.jtcvs.2025.08.030.
Preoperative cardiac computed tomography-derived fractional flow reserve (CT-FFR) and intraoperative transit-time flow measurement (TTFM) values were compared with graft patency after coronary artery bypass grafting (CABG).
One hundred and eight patients who underwent isolated CABG using an in-situ internal thoracic artery (ITA) based composite graft and whose CT-FFR values were obtained were included. TTFM values(mean graft flow[MGF; mL/min], pulsatility index[PI], and diastolic filling percentage[DF%]) were obtained for each anastomosis in all study patients. Early angiographies examined 342 anatomoses performed in all 108 patients, and 1-year angiographies examined 310 anastomoses of 97 patients (89.8%). Angiographic findings of graft flow were categorized as perfectly patent, bidirectionally competitive, unidirectionally competitive, and occluded. Receiver operating characteristic (ROC) curve analysis of CT-FFR and TTFM values for predicting angiographic findings was performed, and cutoff values and area under the curve (AUC) of CT-FFR and TTFM values were identified.
The number of perfectly patent, bidirectionally competitive, unidirectionally competitive and occluded grafts were 281(82.2%), 33(9.6%), 27(7.9%) and 1(0.3%), respectively, in early, and 278(89.7%), 13(4.2%), 8(2.6%) and 11(3.5%), respectively, in 1-year angiograms. CT-FFR values in coronary arteries with perfectly patent, bidirectionally competitive and unidirectionally competitive grafts were significantly different during the year (0.640, 0.807 and 0.816, respectively, in early [P<0.001]; 0.658, 0.841and 0.857, respectively, in 1-year angiograms[P<0.001]. Cutoff values of CT-FFR, MGF, PI, and DF% predicting competitive graft flow were 0.774, 11mL/min, 2.8 and 72%, respectively, in early; 0.767, 12mL/min, 2.8, and 58.0%, respectively, in 1-year angiograms. CT-FFR values predicted the early and 1-year competitive graft flow better than TTFM values (MGF [P<0.001], PI [P<0.001], and DF% [P<0.001]).
Diagnostic accuracy of CT-FFR values for predicting competitive graft flow during the year following CABG using an in-situ ITA-based composite graft was high and superior to TTFM values.
将冠状动脉旁路移植术（CABG）后术前心脏计算机断层扫描衍生的血流储备分数（CT-FFR）和术中通过时间血流测量（TTFM）值与移植血管通畅情况进行比较。
纳入108例行原位胸廓内动脉（ITA）复合移植孤立CABG且获得CT-FFR值的患者。在所有研究患者中，对每个吻合口获取TTFM值（平均移植血管血流[MGF；mL/分钟]、搏动指数[PI]和舒张期充盈百分比[DF%]）。早期血管造影检查了所有108例患者的342个吻合口，1年血管造影检查了97例患者（89.8%）的310个吻合口。移植血管血流的血管造影结果分为完全通畅、双向竞争、单向竞争和闭塞。对CT-FFR和TTFM值预测血管造影结果进行受试者操作特征（ROC）曲线分析，并确定CT-FFR和TTFM值的截断值和曲线下面积（AUC）。
早期完全通畅、双向竞争、单向竞争和闭塞的移植血管数量分别为281条（82.2%）、33条（9.6%）、27条（7.9%）和1条（0.3%），1年血管造影时分别为278条（89.7%）、13条（4.2%）、8条（2.6%）和11条（3.5%）。在这一年中，移植血管完全通畅、双向竞争和单向竞争的冠状动脉的CT-FFR值有显著差异（早期分别为0.640、0.807和0.816[P<0.001]；1年血管造影时分别为0.658、0.841和0.857[P<0.001]）。预测竞争性移植血管血流的CT-FFR、MGF、PI和DF%的截断值在早期分别为0.774、11mL/分钟、2.8和72%；1年血管造影时分别为0.767、12mL/分钟、2.8和58.0%。CT-FFR值预测早期和1年竞争性移植血管血流比TTFM值更好（MGF[P<0.001]、PI[P<0.001]和DF%[P<0.001]）。
使用基于原位ITA的复合移植物进行CABG后，CT-FFR值预测一年内竞争性移植血管血流的诊断准确性高，且优于TTFM值。
