Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 215

Early and late SVG patency is dependent on a good flow through the graft and requires: (i) good distal runoff and good size of the recipient artery (>1.5–2.0 mm) without distal disease; (ii) significant proximal disease in the recipient artery (otherwise, the flow through the recipient artery prevents appropriate flow through the graft); (iii) well-matched size of the graft and recipient artery.^103-105 This dependency on size and flow explains that SVG graft to LAD has higher patency than SVG to RCA or LCx, and that SVG to a diagonal or to a small vessel has the lowest patency. Of note, FFR-guided CABG, wherein only vessels with significant FFR are grafted, did not significantly improve clinical outcomes or graft failure compared to angiography-guided CABG (FARGO trial) (unlike the benefit of FFR-guided PCI);¹⁰⁶ moreover, the disease progressed quickly after CABG, within 6 months, in vessels with insignificant FFR (from a mean of 0.89 to 0.81, with 40% of vessels progressing from insignificant to significant FFR). Also, in a patient who already needs CABG, adding a graft to a moderately obstructed territory may still protect it from infarcts.