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

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.

Safety and feasibility evaluation of planning and execution of surgical revascularisation solely based on coronary CTA and FFRCT in patients with complex coronary artery disease: study protocol of the FASTTRACK CABG study

“…6 In preparation of this first-in-man study, five cardiac surgeons initially involved in the SYNTAX III Revolution trial were asked to review retrospectively the randomised cases allocated to surgery and to decide on an individual basis whether the surgical planning of the cases was feasible based on the sole evaluation of CCTA and FFR CT . 18 In this survey, cardiac surgeons agreed in 84% of cases to plan and perform CABG solely guided by the CCTA information including FFR CT . It means that in 16% of the cases, the surgeon required the viewing of ICA.…”

Cardiac Surgery 2019 Reviewed

“…After the SYNTAX III Revolution trial demonstrated the feasibility to provide treatment recommendation for invasive therapy based on coronary computed tomography (CT) imaging in patients with triple-vessel disease, 21 the same group demonstrated in 2019 that surgeons are able to plan CABG surgery based on the sole availability of CT coronary images in the majority of cases (80%). 22 A trial to test its practical feasibility is underway.…”

A New Diagnostic Algorithm for Examining Patients with Suspected Chronic Coronary Syndrome: Questions Remain?

“…С другой стороны, использование в качестве стандарта инвазивной КАГ уже применялось в более ранних шкалах оценки ПТВ (например, в шкале Diamond-Forester) и вследствие влияния отбора больных, в конечном счете, существенно завышала вероятность наличия ИБС. При настоящем уровне развития диагностических технологий данное противоречие пока не разрешено, но в перспективе решение проблемы видится в использовании неинвазивной оценки состояния коронарного русла с помощью более точных методов МСКТ-ангио-графии коронарных артерий с неинвазивным определением значимости коронарных стенозов [24,25].…”