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Collateral flow reserve and right coronary occlusion: evaluation during off-pump revascularization

^a Department of Thoracic and Cardiovascular Surgery, University Hospital Centre, Rennes, France
^b University of Technology of Compiegne, France

*Corresponding author. Present address: Dr Verhoye Jean Philippe, Department of Cardio Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, 94305-5247, USA. Tel.: +1-650-724-2828; fax: +1-650-725-3846 E-mail address: jverhoye{at}stanford.edu (J.-P. Verhoye).

The aim of this study was the determination of the pressure-derived collateral fractional flow reserve (FFR_coll) in patients with three vessel disease and chronic occlusion of the right coronary artery undergoing surgical complete revascularization with the off-pump technique. The angiograms of eight patients were preoperatively analysed to quantify collaterality. FFR_coll was determined before any revascularization (FFR_coll 0), and after revascularization of the left coronary arteries, (FFR_coll 1). FFR_coll 0 was compared to the Rentrop grade, to the left ventricular ejection fraction (LVEF), and to FFR_coll 1. No correlation was demonstrated between preoperative Rentrop grade and FFR_coll 0. There was a linear statistically significant correlation between FFR_coll 0 and LVEF (P;ie0.001). No significant variation of the FFR_coll index was observed after performing left coronary artery bypass grafts. Collaterality observed on the coronary angiogram cannot be used as an estimation of the functional collaterality, which can be better appreciated with the LVEF. The absence of variation of FFRcoll before and after left coronary artery revascularization suggests that grafting of the occluded right coronary artery remains justified.

Key Words: Angiography; Coronary artery bypass surgery; Off-pump

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