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Right ventricular function after coronary artery bypass grafting in patients with and without revascularization of
U Schirmer1, E Calzia, K H Lindner
1Department of Anesthesiology, University of Ulm, Germany.
Insights
Revascularization of significant right coronary artery stenosis preserves right ventricular function after bypass grafting. Non-revascularized moderate stenosis can lead to right ventricular depression, impacting cardiac performance.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Right coronary artery stenosis can affect right ventricular function.
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- The impact of revascularizing right coronary artery stenosis on right ventricular function requires further evaluation.
Purpose of the Study:
- To assess the influence of revascularizing right coronary artery stenosis on postoperative right ventricular function.
- To compare right ventricular function in patients undergoing CABG with and without revascularization of the right coronary artery.
Main Methods:
- Prospective, single-institution study involving 20 patients undergoing elective CABG.
- Patients were divided into two groups: Group 1 (n=10) with revascularization of significant right coronary artery stenosis, and Group 2 (n=10) without revascularization of non-significant stenosis.
- Right ventricular function was assessed perioperatively using fast-response thermodilution pulmonary artery catheterization.
Main Results:
- Group 1 showed an increase in right ventricular ejection fraction (p < 0.05) and a leftward/upward shift in the pressure-volume relationship, indicating preserved function.
- Group 2 experienced an increase in right ventricular volumes (p < 0.05) and a rightward shift in the pressure-volume relationship, suggesting depression.
- Postoperative right ventricular volumes were higher in Group 2 compared to Group 1 (p < 0.05).
Conclusions:
- Revascularization of significant right coronary artery stenosis appears to preserve postoperative right ventricular function.
- Moderate right coronary artery stenosis not addressed during CABG may lead to right ventricular depression.
- These findings highlight the importance of considering right coronary artery revascularization for optimal right ventricular performance post-CABG.
Objectives:
To evaluate the influence of revascularization of a stenosis of the right coronary artery on right ventricular function.
Design:
Prospective study.
Setting:
Single institutional study in a university hospital.
Participants:
20 patients with different degrees of stenosis of the right coronary artery undergoing elective coronary artery bypass grafting.
Interventions:
In 10 patients, bypass surgery included revascularization of a significant stenosis of the right coronary artery (group 1). In 10 other patients, the pathology of the right coronary artery was judged to be not significant, without indication for revascularization (group 2).
Measurements And Main Results:
Using the fast-response thermodilution pulmonary artery catheter, right ventricular function was estimated perioperatively. After termination of extracorporeal circulation, there was an increase in right ventricular volumes in group 2 (p < 0.05) and an initial decrease in group 1 (p < 0.05), with higher volumes in group 2 compared with group 1 (p < 0.05). The ejection fraction increased in group 1 (p < 0.05) and decreased in group 2 after operation (p < 0.05), with higher values in group 1 compared with group 2 (p < 0.05). In addition to these findings, the pressure-volume relationship showed a leftward and upward shift in group 1 and a rightward shift in group 2 postoperatively.
Conclusions:
These results indicate that right ventricular depression can occur after bypass grafting in patients with a moderate stenosis of the right coronary artery that is not revascularized. Revascularization of more severe stenosis of the right coronary artery appears to preserve postoperative right ventricular function.