A comparison of left ventricular function in patients undergoing beating heart bypass surgery using mixed versus pure venous conduits

Tarun Chaudhary; Hemant Kumar Nautiyal; Aratatran Nahak; Shantanu Sahu

doi:10.18203/2349-2902.isj20171604

Authors

Tarun Chaudhary Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Jolly Grant, Dehradun, India
Hemant Kumar Nautiyal Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Jolly Grant, Dehradun, India
Aratatran Nahak Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Jolly Grant, Dehradun, India
Shantanu Sahu Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Jolly Grant, Dehradun, India

DOI:

https://doi.org/10.18203/2349-2902.isj20171604

Keywords:

Left internal mammary artery, LVEF, Mixed conduits, Venous conduits

Abstract

Background: The pathophysiology of coronary artery disease was established in 1876 by Adam Hammer when he postulated that angina is caused by interruption of coronary blood supply and that myocardial infarction occurred after the occlusion of at least one coronary artery. Aims of the study were to compare the left ventricular function in patients who have undergone beating heart bypass surgery using mixed (internal mammary artery and venous conduits) versus pure Venous conduits, and to compare the incidence of postoperative complications.

Methods: It was an observational, analytical study. All patients admitted with triple vessel disease requiring CABG (n=50), with ejection fraction >30%, were subjected to either left internal mammary artery and venous conduits (group A, n=25) or only venous conduits (group B, n=25). Patient who had undergone prior surgical myocardial revascularization, preexisting valvular disease, any evidence of raised pulmonary arterial pressure more than 40/15 mmHg, operated using cardiopulmonary bypass machine, pre-operative use of Intra-Aortic Balloon Pump, any history of neurological dysfunction/Transient ischemic attack, left atrium size more than 5.5 cm were excluded from the study

Results: Improvement in left ventricular function after coronary artery bypass grafting was objectively demonstrated in both the groups. There was a statistically significant increase in mean LVEF in group B (56.16±4.13) compared to group A (51.96±5.30) at 3 months of follow up (p=0.009). The most common complication in both the groups were atrial fibrillation group A=36% (n=9), group= B 16 % (n=4), renal failure group A=12% and group B=8% and sternal wound infection. The post-operative bleeding (Drain output) in first 24 hours was similar in both the groups, 295.56 ml in group A and 265.20ml in group B (p=) with similar hospital stay (group A=9days, group B=8.5days).

Conclusions: Patients with venous conduits have better postoperative LVEF as compared to Mixed conduit with similar rate of post-operative complications.

Metrics

Metrics Loading ...

References

Westaby S. The foundations of cardiac surgery. Landmarks in Cardiac Surgery. 1997:1-47.

Padmanabhan S, Hastie C, Prabhakaran D, Dominczak AF. Genomic approaches to coronary artery disease. Indian J Med Rese. 2010;132(5):567.

Writing Group Members, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. 2016;133:447-54.

Huffman MD. Coronary Heart Disease in India. Center for Chronic Disease Control. Indian Council of Medical Research. Available at: http://www.icmr.nic.in/ biomarkers/ biomarkers.htm. Accessed 29 September 2009

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349:1498-504.

Srinath RK, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet 2005;366:1744-9.

Salick MM, Qadir I, Perveen S, Furnaz S, Sharif H. Trends in coronary artery bypass surgery: impact on early outcomes. Asian Cardiovascular and Thoracic Annals. 2013;21(4):402-8.

Bouchart F, Tabley A, Litzler PY, Haas-Hubscher C, Bessou JP, Soyer R. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg. 2001;20(6):1157-62.

Taggart DP, Lees B, Gray A, Altman DG, Flather M, Channon K. Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularization. Trials. 2006;7(1):1.

Bonow RO. Identification of viable myocardium. Circulation. 1996;94(11):2674-80.

Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999;117(5): 855-72.

Cohn LH. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation. 2001;103(4):483-4.

Akasaka T, Yoshikawa J, Yoshida K, Maeda K, Hozumi T, Nasu M et al. Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire: comparison with saphenous vein grafts. J American Coll Card. 1995;25(3): 640-7.

Shumacker HB. The evolution of cardiac surgery. Indiana University Press. 1992.

Cooper DK. Open heart: the radical surgeons who revolutionized medicine. Kaplan Pub. 2010.

Duhaylongsod FG, Mayfield WR, Wolf RK. Thoracoscopic harvest of the internal thoracic artery: a multicenter experience in 218 cases. The Annals of thoracic surgery. 1998;66(3):1012-7.

Green GE, Stertzer SH, Gordon RB, Tice DA. Anastomosis of the internal mammary artery to the distal left anterior descending coronary artery. Circulation. 1970;41(5 Suppl):II79-85.

Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89(2): 248-58.

Lorusso R, La Canna G, Ceconi C, Borghetti V, Totaro P, Parrinello G et al. Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium. Eur J Cardiothorac Surg. 2001;20(5):937-48.

Jegaden O, Bontemps L, de Gevigney G, Eker A, Montagna P, Chatel C et al. Does the extended used of arterial grafts compromise the myocardial recovery after coronary artery bypass grafting in left ventricular dysfunction? Eur J Cardiothorac Surg. 1998;14(4):353-9.

Choudhary AK, Singh C, Padia A, Sood AK, Singh R. Abstracts of the 59th Annual conference of IACTS. Indian J ThoracCardiovasc Surg. 2013;29(1):57-81.

Edwards FH, Clark RE, Schwartz M. Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg. 1994;57(1):27-32.

Gaziano TA. Economic burden and the cost-effectiveness of treatment of cardiovascular diseases in Africa. Heart. 2008;94(2):140-4.

Mehsood DK, Khan MA, Iqbal MA, Janjua AM, Kiani MR. Vein grafts to left anterior descending (lad) in emergency coronary artery bypass graft (cabg) of elderly–does it merit? Pak Armed Forces Med J. 2015;65(Suppl):S11-5.

Tyras DH, Barner HB, Kaiser GC, Codd JE, Pennington DG, Willman VL. Bypass grafts to the left anterior descending coronary artery: saphenous vein versus internal mammary artery. J Thorac Cardiovasc Surg. 1980;80(3):327-33.

Sethi GK, Copeland JG, Moritz T, Henderson W, Zadina K, Goldman S. Comparison of postoperative complications between saphenous vein and IMA grafts to left anterior descending coronary artery. Ann Thorac Surg. 1991;51(5):733-8.

Skorpil J, Brat R, Docekal B, Motyka O. Myocardial revascularisation in patients with severe left ventricular dysfunction. Early and midterm results. Women. 2004;15:15-5.

Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P et al. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008;118(16):1612-8.

Topkara VK, Cheema FH, Kesavaramanujam S, Mercando ML, Cheema AF, Namerow PB et al. Coronary artery bypass grafting in patients with low ejection fraction. Circulation. 2005;112(9 suppl):I-344.

Abraham VS, Swain JA. Cardiopulmonary bypass and kidney. In: Gravlee GP, Davis R, editors. Cardiopulmonary Bypass: Principles and Practice. Philadelphia (USA): Lippincott Williams & Wilkins. 2000:382-91.

Ergunes K, Yurekli I, Lafcı B, Gokalp O, Akyuz M, Yetkin U et al. Coronary surgery in patients with low ejection fraction: mid-term results. Asian Cardiovasc Thorac Ann. 2013;21(2):137-41.

Leavitt BJ, O’Connor GT, Olmstead EM, Morton JR, Maloney CT, Dacey LJ et al. Northern New England Cardiovascular Disease Study Group. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation. 2001;103(4):507-12.

Karthik S, Srinivasan AK, Grayson AD, Jackson M, Mediratta NK. Left internal mammary artery to the left anterior descending artery: effect on morbidity and mortality and reasons for nonusage. Ann Thorac Surg. 2004;78(1):142-8.

Jones JW, Ochsner JL, Mills NL, Hughes L. Clinical comparison between patients with saphenous vein and internal mammary artery as a coronary graft. J Thorac Cardiovasc Surg. 1980;80(3):334-41.