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[Surgical revascularization of the myocardium in patients with chronic coronary disease and depressed left
Z Gasior1, A Bochenek, B Gorycki
1I Klinika Kardiologii IK Sl. A. M. w Katowicach.
Insights
Coronary artery bypass grafting (CABG) improves left ventricular (LV) systolic function in patients with severely depressed ejection fraction (LVEF) over one year. Both crystalloid and blood cardioplegia showed similar hemodynamic effects post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Coronary artery bypass grafting (CABG) is crucial for ischemic heart disease with depressed left ventricular (LV) function.
- While beneficial, CABG's precise impact on LV hemodynamics, especially with varying cardioplegia types, requires clarification.
Purpose of the Study:
- To assess CABG's effect on LV hemodynamics in patients with low LV ejection fraction (LVEF).
- To compare the influence of crystalloid (CC) versus blood (BC) cardioplegia on LV function post-CABG over one year.
Main Methods:
- 122 patients with stable angina undergoing CABG were divided into LVEF ≤ 40% (Group I) and LVEF > 40% (Group II).
- Patients were randomized to CC or BC cardioplegia.
- Echocardiography assessed LVEF and wall motion score index (WMSI) pre-CABG and at 5 time points up to 1 year post-CABG.
Main Results:
- In Group I (LVEF ≤ 40%), LVEF and WMSI significantly improved over 1 year (p < 0.001), particularly in those with LVEF ≤ 30%.
- Group II (LVEF > 40%) showed transient LVEF deterioration 2-6 weeks post-CABG (p < 0.05).
- No significant differences in LVEF or WMSI were observed between CC and BC subgroups (Ia vs Ib, IIa vs IIb) at any time point.
Conclusions:
- CABG significantly improves LV systolic function in patients with severely depressed hemodynamics within one year.
- The choice between CC and BC cardioplegia does not appear to influence the early or long-term hemodynamic outcomes of CABG.
Abstract:
Many reports confirm the importance and benefit of the surgical revascularization (CABG) in patients with ischemic heart disease and severely depressed left ventricular (LV) systolic function. This mode of treatment is better than medical therapy in patients with very low LV ejection fraction (LVEF) and can prolong the life. However, the effect of CABG on LV hemodynamics is still unclear. The aim of the study was: 1) to assess the effect of CABG on LV hemodynamics in patients with low LVEF and 2) to examine the influence of two types of cardioplegia-crystalloid (CC) and blood (BC) cardioplegia--on LV function during 1 year follow-up. 122 patients with stable angina pectoris qualified for CABG were included in the study. Patients were divided into two groups: group I-47 pts with LVEF < or = 40% and group II--75 pts with LVEF > 40% and then patients were randomized for two types of antegrade-retrograde cardioplegia (CC--subgroups Ia, IIa and BC--subgroups Ib, IIb). Before operation and 4 times after CABG (after 2-6 weeks, 3 months, 6 months and 1 year) echocardiographic examination was performed. Diameters of left atrium and ventricle, LVEF and wall motion score index (WMSI) were calculated. During 1 year 8 patients died (5 of them during perioperative period and 3 patients during follow-up). Patients in group I before operation were in higher NYHA and CCS class and had more often myocardial infarction. During each of the five echocardiographic examination the values of LVEF and WMSI did not differ between subgroups Ia vs Ib and IIa vs IIb. In group I, especially in patients with very low LVEF < or = 30%, the values of LVEF and WMSI improved significantly (p < 0.001) during 1 year of follow-up. But in group II a transient deterioration of LVEF (p < 0.05) 2-6 weeks after CABG was noted. We conclude that surgical revascularization in patients with severe depressed hemodynamics improves LV systolic function during 1 year follow-up. The use of CC or BC did not seem to make any difference to the early and long-term hemodynamic effect of the revascularization.