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Published on: March 27, 2018
Right ventricular function after coronary artery bypass graft surgery--a magnetic resonance imaging study
Subodh B Joshi1, Robert O Roswell, Ali K Salah
1Section of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC, USA.
Insights
Coronary artery bypass graft surgery (CABG) does not adversely affect long-term right ventricular function. Post-CABG, right ventricular ejection fraction improved, especially in patients with initially low function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Right ventricular dysfunction is common early after coronary artery bypass graft surgery (CABG).
- The long-term impact of CABG on right ventricular function requires further investigation.
Purpose of the Study:
- To evaluate the sustained effect of CABG on right ventricular function.
- To assess changes in right ventricular ejection fraction three months post-CABG.
Main Methods:
- Cardiac magnetic resonance imaging (CMR) was utilized.
- 28 patients undergoing elective CABG were assessed pre- and post-surgery (3 months).
- Right ventricular ejection fraction was measured using cine images.
Main Results:
- Left ventricular ejection fraction significantly increased post-CABG (50% to 58%).
- Right ventricular ejection fraction also significantly improved (54% to 60%).
- Patients with baseline RV ejection fraction below 53% showed marked improvement (47% to 57%), irrespective of on-pump or off-pump procedures.
Conclusions:
- Coronary artery bypass graft surgery does not lead to long-term adverse effects on right ventricular function.
- An improvement in right ventricular function was observed post-CABG, particularly in patients with lower baseline function.
- The observed improvement in right ventricular function was consistent between on-pump and off-pump CABG procedures.
Background:
A reduction in right ventricular function commonly occurs in the early postoperative period after coronary artery bypass graft surgery (CABG). We sought to determine the longer-term effect of CABG on right ventricular function.
Methods:
Cardiac magnetic resonance imaging was performed before and approximately 3 months after surgery in 28 patients undergoing elective CABG. Right ventricular (RV) ejection fraction was assessed by planimetry of electrocardiographically gated cine images.
Results:
There was a statistically significant increase in left ventricular ejection fraction from 50% to 58% (P=.003) after CABG. RV ejection fraction also increased from 54% to 60% (P=.002). In patients with lower baseline RV ejection fraction (below the median, < 53%), this parameter improved from 47% to 57% (P<.001). Both on-pump (47% vs. 62%, P=.003) as well as off-pump CABG (47% vs. 55%, P=.009) lead to an improvement in RV function in patients in the initial low RV ejection fraction group.
Conclusion:
Long-term right ventricular function was not adversely affected by CABG. An improvement in RV function occurred after surgery in patients with low baseline RV ejection fraction and was similar in patients who underwent surgery with or without cardiopulmonary bypass.
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