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Published on: March 27, 2018
Early effects of coronary artery bypass grafting on left ventricular regional wall motion abnormalities
Muhammad Asad Bilal Awan1, Arif ur-Rehman Khan, Tariq A Siddiqi
1Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. drasadawan@hotmail.com
Insights
Coronary Artery Bypass Grafting (CABG) surgery improves early left ventricular wall motion in most areas, particularly the posterior and inferior walls. However, some anterior and septal segments may show deterioration after CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Coronary Artery Disease (CAD) significantly impacts left ventricular function.
- Assessing regional left ventricular wall motion is crucial for understanding cardiac health post-intervention.
Purpose of the Study:
- To evaluate the immediate effects of Coronary Artery Bypass Grafting (CABG) on regional left ventricular wall motion abnormalities.
- To compare the impact of different graft types on myocardial function recovery.
Main Methods:
- A quasi-experimental study involving 100 adult patients undergoing elective CABG.
- Pre-operative and post-operative echocardiography (4th-6th day) to assess segmental left ventricular wall motion.
- Analysis of wall motion changes in basal, mid, and apical segments.
Main Results:
- Early improvement in segmental wall motion observed in posterior and inferior walls post-CABG.
- Deterioration in segmental wall motion noted in the anterior interventricular septum (p=.001).
- Insignificant effects on anterior (p=.609) and anterolateral (p=.078) wall motion abnormalities.
Conclusions:
- Myocardial revascularization via CABG enhances early left ventricular regional wall motion, especially when using Saphenous Vein Graft (SVG).
- Limited improvement in early segmental wall motion was observed in areas revascularized with Left Internal Mammary Artery (LIMA).
Objective:
To determine the early effects of Coronary Artery Bypass Grafting (CABG) on regional left ventricular wall motion abnormality in patients undergoing surgery for proven Coronary Artery Disease (CAD).
Design:
Quasi-experimental study.
Place And Duration Of Study:
Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. from October 2005 to April 2006.
Patients And Methods:
A total of a 100 adult patients who underwent elective CABG were selected. Pre-operative echocardiography was done to note if segmental left ventricular wall motion at basal, mid and apical levels were normal, hypokinetic, akinetic, dyskinetic, or aneurysmal. Postoperative echocardiography was done between 4th and 6th day and change in left ventricular segmental wall motion was noted.
Results:
Seventy-five patients (n=75) were included in the analysis. These results showed that effect of CABG on anterior segmental wall motion abnormalities was insignificant (p=.609), the effect on the anterior IVS showed deterioration of segmental wall motion and this effect was significant (p=.001), effect is insignificant on anteriolateral segmental wall motion abnormalities (p=.078), normal pre-operative segments in posterior wall showed stability (p=.664) while disappearance of dyskinetic, reduction in akinetic segments postoperatively and inferior wall motion have same effects as of posterior wall. Comparison of pre-operative and postoperative echocardiographic data revealed early improvement in segmental wall motion of posterior and inferior wall, while alterations in segmental wall motion of anterior, anterior-lateral and septal wall.
Conclusion:
Myocardial revascularization by CABG improves early left ventricular regional wall motion abnormalities where SVG is used as conduit for revascularization whereas no significant improvement occurs in early segmental wall motion in areas revascularized by LIMA.
