Innovative CABG procedure reduces morbidity in a specific population

A team of researchers compared 2 coronary artery bypass grafting (CABG) procedures in patients undergoing valve surgery who also had concomitant coronary artery disease (CAD). The more advanced of the 2 approaches yielded superior cardiovascular outcomes. 

The FAVOR IV-QVAS trial (NCT03977129) enrolled 793 adult participants scheduled for surgery for primary valve disease who also had CAD, defined as at least 1 coronary angiography (CAG)-estimated stenosis ≥50% in a major coronary artery suitable for CABG. “In participants with valvular heart disease undergoing preoperative CAG screening, coronary lesions are often stable and anatomically uncomplex,” explained Prof. Qiang Zhao (Ruijin Hospital Shanghai JiaoTong University School of Medicine, China) [1].

Participants were randomised 1:1 to undergo either anatomically CAG-guided CABG or physiologically AngioFFR-guided CABG. The primary outcome was a composite of all-cause death, myocardial infarction, stroke, unplanned revascularisation, and new renal failure requiring dialysis within 30 days post-surgery.

The primary composite endpoint favoured the AngioFFR-guided group over the CAG-guided group (7.8% vs 13.4%; RR 0.58; 95% CI 0.38-0.89; P=0.01). This effect appeared to be mainly driven by a reduction in myocardial infarction in the AngioFFR-guided arm (1.5% vs 5.6%; RR 0.27; 95% CI 0.11-0.67). “At a median follow-up of 27 months, the key secondary composite endpoint, comprising adverse cardiovascular outcomes, also favoured the AngioFFR-guided arm (HR 0.74; 95% CI 0.55-0.98; P=0.04),” noted Prof. Zhao.

In summary, the FAVOR IV-QVAS trial supports the use of a physiological lesion assessment to guide surgical coronary revascularisation in patients undergoing valve surgery, potentially reducing postoperative morbidity and improving long-term cardiovascular outcomes.

1. Zhao Q, et al. Angiography-derived FFR-guided coronary artery bypass grafting for patients undergoing valve surgery with concomitant coronary artery disease: the FAVOR IV-QVAS trial. AHA scientific sessions 2025, 7-10 November, New Orleans, LA, USA.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 13 November 20255 December 2025