Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial.

AIMS: Visual estimation is the most commonly used method to evaluate the degree of coronary artery stenosis prior to coronary artery bypass grafting. In interventional cardiology, the use of fractional flow reserve (FFR) to guide revascularization decisions has become routine. We investigated whether the preoperative FFR measurement of coronary lesions is associated with anastomosis function 6 months after surgical revascularization using a multiarterial grafting strategy. METHODS AND RESULTS: In this prospective double-blind study, 67 patients were enrolled from two institutions in Europe and Canada. From these patients, 199 coronary lesions were assessed visually and with FFR at the time of the preoperative angiogram. All patients received coronary revascularization using multiple arterial grafts. A post-operative 6-month angiogram was performed to assess anastomosis functionality using a described angiographic method. The primary outcome was the association between preoperative FFR values and anastomosis function 6 months after surgery. Preoperative FFR was significantly associated with 6-months anastomotic function for all conduits and for all targets (P < 0.001). An FFR value of ≤0.78 was associated with an anastomotic occlusion rate of 3%. CONCLUSION: We found a significant association between the preoperative FFR measurement of the target vessel and the anastomotic functionality at 6 months, with a cut-off of 0.78. Integration of FFR measurement into the preoperative diagnostic workup before multiarterial coronary surgical revascularization leads to improved anastomotic graft function. CLINICAL TRIALS. GOV IDENTIFIER: NCT02527044.

Atrial fibrillation and cardiac rehabilitation: an overview.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its frequency will only continue to increase in the future. Despite available drug and electrophysical treatments, death and functional restrictions due to AF are still common. More comprehensive standards of care are therefore needed.Purpose: After a foreword regarding the link between physical activity and AF, this article aims to give to the clinician an overview of the benefits he may expect or not when including patients suffering from AF in a cardiac rehabilitation programme.Method: We selected prospective, randomised controlled trials published during the past 10 years and referenced in the PubMed Database evaluating the safety of rehabilitation and/or its impact on AF incidence or tolerance, and tried to summarise them to propose a narrative review.Conclusion: Cardiac rehabilitation, along with moderate and regular physical activity, has been proven to reduce the time in arrhythmia of patients with paroxysmal and persistent AF. In chronic AF, cardiac rehabilitation may decrease the resting ventricular response rate in patients and therefore improve symptoms linked to arrhythmia. These studies have managed to demonstrate cardiac rehabilitation as a safe and manageable option for AF patients, without serious risk of additional side effects. Its efficiency to limit the occurrence of serious undesirable outcomes, such as mortality and hospitalisation, has not been adequately demonstrated, likely due to the small scale of most studies and lack of long-term follow-up. Large-scale and long-term studies are thus desirable.

Transcatheter left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: results from the Belgian registry.

AIMS: This study aimed to assess the safety and efficacy at midterm follow-up of left atrial appendage occlusion (LAAO) using different devices, in real life in Belgium. METHODS AND RESULTS: Between June 2009 and November 2016, 457 consecutive patients (63% male, 75±12 yrs, CHA2DS2-VASc 4±0.6, HAS-BLED 3.5±0.7) undergoing LAAO were included. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three deaths (0.6%), nine tamponades (1.9%), four major bleedings (0.8%) and two device embolisations (0.4%). Among patients successfully implanted having a complete follow-up (672 patient-years, median follow-up 370 days), the actual annual stroke rate was 1.2%, lower than the expected stroke risk of 4% (70% reduction). The observed bleeding rate was 2%, while the calculated risk was 3.7% (46% reduction). Kaplan-Meier analysis showed a similar overall survival (93±2% and 87±3% versus 91±3% and 87±4%; p=0.35) and event-free survival (92±2% and 84±3% versus 88±3% and 80±5%; p=0.17) at one and two years, for the ACP/Amulet versus the WATCHMAN groups of patients, respectively. CONCLUSIONS: The data from the Belgian left atrial appendage occlusion registry suggest that the procedure is effective and relatively safe in a real-world setting, using either the WATCHMAN or the ACP/Amulet device.