[On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: a
D X Liu1, X J Chen2, B S Zheng3
1Department of Cardiac Surgery, the First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China.
Insights
Total arterial revascularization using bilateral radial artery (BRA) and left internal mammary artery (LIMA) conduits is safe and effective for coronary artery bypass grafting (CABG) patients with left ventricular dysfunction (LVD). This approach improved heart function and showed high graft patency in a retrospective study.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Left ventricular dysfunction (LVD) poses significant challenges in coronary artery bypass grafting (CABG).
- Total arterial revascularization (TAR) aims to improve long-term outcomes compared to traditional venous grafts.
- The use of bilateral radial artery (BRA) and left internal mammary artery (LIMA) conduits in TAR for LVD patients requires further clinical evaluation.
Purpose of the Study:
- To assess the clinical outcomes of on-pump TAR using BRA and LIMA conduits in CABG patients with LVD.
- To evaluate the safety and efficacy of this arterial grafting strategy in a cohort of patients with reduced left ventricular ejection fraction (LVEF).
Main Methods:
- Retrospective analysis of 87 patients with LVEF ≤ 40% undergoing on-pump CABG with BRA and LIMA conduits.
- Data collected from 24 heart centers in China between July 2015 and December 2019.
- Evaluation of perioperative outcomes, postoperative complications, and long-term graft patency via coronary CT angiography.
Main Results:
- Mean LVEF improved from 35.5% preoperatively to 45.2% at 3 months post-surgery (P=0.001).
- Mean left ventricular end-diastolic diameter decreased from 65.5 mm to 53.0 mm (P=0.02).
- Graft patency was 98.8% at a mean follow-up of 30.5 months, with only one radial artery occlusion.
Conclusions:
- On-pump total arterial revascularization with BRA and LIMA conduits is a safe and effective strategy for selected CABG patients with LVD.
- This approach leads to significant improvements in left ventricular function and excellent long-term graft patency.
Abstract:
Objective: To evaluate the clinical outcomes of on-pump total arterial revascularization with bilateral radial artery (BRA) and left internal mammary artery (LIMA) as conduits in coronary artery bypass grafting (CABG) patients with left ventricular dysfunction (LVD). Methods: All the perioperative medical records and follow-up results of coronary artery disease patients with left ventricular ejection fraction (LVEF) ≤ 40% undergoing CABG from 24 heart centers of 15 provinces and autonomous regions in China between July 2015 and December 2019 were retrospectively analyzed. Results: A total of 87 consecutive patients (55 males and 32 females) underwent on-pump CABG with BRA and LIMA, with a mean age of (57.5±9.1) years old. There were 22 patients complicated with primary hypertension, 12 with diabetes mellitus, 8 with peripheral vascular disease, 7 with chronic obstructive lung disease, 12 with mild renal injury and 3 with partial aortic calcification. There were 43 cases with in-stent stenosis, and 21 had left main disease. The mean LVEF and left ventricular end-diastolic diameter (LVEDD) was (35.5±7.3)% and (65.5±2.6) mm, respectively. The mean graft number, aortic cross-clamp time and cardiopulmonary bypass duration was 3.2±0.9, (90.5±22.7) min and (113.4±19.2) min, respectively. There were 32 mitral and 9 aortic valve replacements, and 5 tricuspid annuloplasties. Prophylactic intra-aortic balloon pumps were implanted in 27 patients. There were 2 operative deaths from acute heart failure. After surgery, there were 15 cases of atrial fibrillation, 1 case of acute kidney injury, 1 case of acute myocardial infarction, and 1 cases of stroke. All the patients fulfilled the follow-up, with a mean time of (39.5±7.7) months. At 3 months after surgery, LVEDD was decreased and LVEF was improved significantly compared with pre-operative indicators [(53.0±1.5) mm vs (65.5±2.6) mm, t=9.51 P=0.02; (45.2±3.3)% vs (35.5±7.3)%, t=13.79, P=0.001]. No major cardiac events were reported during the follow-up. At (30.5±7.4) months after surgery, 62.4% of patients (53/85) underwent coronary CT angiography examination, and the results indicated that the graft patency was 98.8%, with only one case of RA occlusion occurred. Conclusion: In selected patients of LVD, on-pump total arterial revascularization with BRA and LIMA conduits was proved to be safe and effective.
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