Predicitive Value of Quantitative Coronary Analysis for Intraoperative Flow Measurements and Fractional Flow Reserve in Isolated Off-pump Coronary Artery Surgery

Kuipers, E. (Ellen) (2015) Predicitive Value of Quantitative Coronary Analysis for Intraoperative Flow Measurements and Fractional Flow Reserve in Isolated Off-pump Coronary Artery Surgery. thesis, Medicine.

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Abstract

Background: Preoperative quantitative coronary analysis (QCA) and intraoperative graft flow measurements may be of value in predicting competitive flow. Objectives: To assess the predictive value of preoperative severity of coronary stenoses measured by QCA for intraoperative flow measurements as mean flow (MF), pulsatility index (PI) and backward flow (%BF) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Our aim is to create a preoperative risk model for competitive flow. Secondary, we evaluated QCA to predict fractional flow reserve (FFR) and we compared visual estimated lesion severity with QCA-derived degree of stenosis. Methods: Seventy-two patients underwent OPCAB surgery with a left internal mammary artery (LIMA) graft to left anterior descending artery (LAD) and intraoperative graft flow measurements from September 2012 till August 2014. Degree of stenosis was measured with QCA and FFR, and was visually assessed. We investigated the correlation between QCA and intraoperative flow measurements, between QCA and FFR and between lesion severity by visual inspection and QCA. Results: Neither MF and PI, nor %BF showed a significant correlation with preoperative degree of stenosis. No significant correlation was found between 33 FFR measurements and QCA. A moderate to good significant correlation was found between visual inspection and QCA-derived degree of stenosis in the left main coronary artery and the proximal LAD (r-values of 0.699 and 0.509, respectively). There was a trend towards a significant correlation in the mid LAD (r = 0.197, P = 0.079). Conclusions: The principal finding of this study is that QCA is not a clear predictor for intraoperative flow measurements and FFR. Visual assessment tends to overestimate the degree of stenosis compared with QCA. Therefore, it remains important to perform FFR in clinical decision-making. Hemodynamic parameters need to be taken into account in future research with larger series of data.

Item Type:	Thesis (Thesis)
Supervisor name:	Halfwerk, Drs. F. technical medical and Mecozzi, Dr. G. cardio-thoracic surgeon and Medisch Spectrum Twente, Enschede and Department of Cardiothoracic Surgery
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/475

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