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[A clinical study of the left ventricular wall motion after coronary artery bypass grafting using right
Insights
Coronary artery bypass grafting (CABG) using only arterial grafts showed significant improvement in left ventricular (LV) wall motion for both ischemia and infarction. The right gastroepiploic artery (RGEA) demonstrated comparable effectiveness to the left and right internal thoracic arteries (LITA/RITA).
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting in CABG
Context:
- Coronary artery bypass grafting (CABG) is a critical intervention for ischemic heart disease.
- The choice of arterial grafts impacts long-term graft patency and myocardial function.
- Evaluating the efficacy of different arterial conduits is essential for optimizing surgical strategies.
Purpose:
- To assess the functional recovery of left ventricular (LV) regional wall motion following CABG using exclusively arterial grafts.
- To compare the effectiveness of left internal thoracic artery (LITA), right internal thoracic artery (RITA), and right gastroepiploic artery (RGEA) in improving myocardial function post-CABG.
- To determine if RGEA offers comparable benefits to LITA and RITA in treating myocardial ischemia and infarction.
Summary:
- A study evaluated 135 patients undergoing CABG with only arterial grafts from 1989-1993, analyzing pre- and post-operative left ventriculography in 115 cases.
- Regional LV wall motion improvement rates were calculated for ischemic (193 branches) and infarcted (89 branches) territories.
- For ischemia, improvement rates were LITA 55.0%, RITA 63.2%, RGEA 75.0%. For infarction, rates were LITA 42.1%, RITA 55.6%, RGEA 52.9%. No significant differences were observed between graft types for either condition.
Impact:
- The findings suggest that the right gastroepiploic artery (RGEA) is a viable and effective arterial graft option for CABG, comparable in functional improvement to the widely used internal thoracic arteries.
- This research supports the expanded use of RGEA in CABG procedures, potentially increasing arterial grafting options and improving patient outcomes.
- The study contributes to the evidence base for arterial grafting strategies in coronary revascularization, emphasizing functional recovery of the left ventricle.
Abstract:
From 1989 to 1993 we performed coronary artery bypass grafting (CABG) using only arterial grafts in 135 cases. Both pre- and post-operative left ventriculography (LV graphy) were evaluated in 115 cases (282 branches). In accordance with the American Heart Association (AHA) classification, the left ventricular (LV) wall was divided into seven segments and the LV regional wall motion was assessed as per five grade. The rate of improvement (%) was defined as follows: (number that showed improvement of regional LV wall motion on post-operative LVgraphy/number that showed decreased regional LV wall motion on pre-operative LVgraphy) x 100. Examination was made separately regarding cases of ischemia (193 branches) and infarction (89 branches). For ischemic cases, the rate of improvement using left internal thoracic artery (LITA), right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) was 55.0% (11/20), 63.2% (12/19) and 75.0% (12/16) respectively. For infarction cases, the rate of improvement using LITA, RITA and RGEA was 42.1% (8/19), 55.6% (5/9) and 52.9% (18/34) respectively. Among these three groups no significant differences were noted. As a result, RGEA is thought to have usefulness equivalent to LITA and RITA.