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

Jeroen Sonck; Yosuke Miyazaki; Carlos Collet; Yoshinobu Onuma; Taku Asano; Kuniaki Takahashi; Norihiro Kogame; Yuki Katagiri; Rodrigo Modolo; Patrick W Serruys; Antonio L Bartorelli; Daniele Andreini; Torsten Doenst; Juan Pablo Maureira; Andre Plass; Mark La Meir; Giulio Pompillio

doi:10.1093/icvts/ivz046

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

Interact Cardiovasc Thorac Surg. 2019 Aug 1;29(2):209–216. doi: 10.1093/icvts/ivz046. Epub 2019 Mar 18.

Authors

Jeroen Sonck^{1

2}, Yosuke Miyazaki³, Carlos Collet^{1

4}, Yoshinobu Onuma^{3

5}, Taku Asano⁴, Kuniaki Takahashi⁴, Norihiro Kogame⁴, Yuki Katagiri⁴, Rodrigo Modolo⁴, Patrick W Serruys^{5

6}, Antonio L Bartorelli^{7

8}, Daniele Andreini^{8

9}, Torsten Doenst¹⁰, Juan Pablo Maureira¹¹, Andre Plass¹², Mark La Meir¹, Giulio Pompillio^{8

9}

Affiliations

¹ Department of Cardiology and Cardiovascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.
² Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
³ Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.
⁴ Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
⁵ Cardialysis BV, Rotterdam, Netherlands.
⁶ Department of Cardiology, Imperial College of London, London, UK.
⁷ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
⁸ Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁹ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
¹⁰ Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
¹¹ Department of Cardiovascular Surgery, CHRU Nancy, Nancy, France.
¹² Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.

PMID: 30887024
DOI: 10.1093/icvts/ivz046

Abstract

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.

Keywords: Computed tomography-derived fractional flow reserve; Coronary artery bypass grafting; Coronary computed tomography angiography; Left main or 3-vessel coronary artery disease; SYNTAX score; Stable coronary artery disease.