The FAVOR IV-QVAS trial compared two approaches to surgical revascularization in patients undergoing heart valve surgery with concomitant coronary artery disease.[1] The first group of patients was guided by a physiologically controlled method using angiographically derived fractional flow reserve (Angio-FFR), while the second group was guided by conventional angiography.[1] The results showed that the physiologically controlled method reduced perioperative complications by almost half compared to the conventional approach.[1] The primary study objective was to measure composite outcomes including death, myocardial infarction, stroke, unplanned coronary revascularization, and new renal failure requiring dialysis within 30 days after surgery.[1] At a median follow-up of 30 months, the Angio-FFR group showed better outcomes in the secondary composite endpoint (20.7% vs. 26.8%; hazard ratio 0.74; p=0.04).[1] These findings suggest that Angio-FFR may be a useful tool in surgical planning, allowing surgeons to tailor revascularization to hemodynamically relevant lesions.[1]