Can Right Ventricular Branch Bypass Alleviate Right Ventricular Dysfunction?

Abstract

Background Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study sought to determine whether additional bypass of an RV branch would lessen RV dysfunction. Methods Patients with severe right coronary artery (RCA) stenosis were divided into 2 groups. Group 1 patients (n = 50) had a single distal bypass on the RCA. Group 2 patients (n = 50) had both distal RCA and additional bypass on the RV branch of the RCA. Right ventricular function was examined by echocardiogram by measuring transannular plane systolic excursion, fractional area change, tissue Doppler S⊠-wave velocity, and inferior vena cava diameter. Results Transannular plane systolic excursion and fractional area change measurements rapidly decreased below the cutoff in both groups, but group 2 patient values reached normal limits at 90 days. Tissue Doppler S⊠-wave velocity reached the normal limit in 7 days. Inotropic agents were required in 11 patients in group 1 and 2 patients in group 2 (P = .013). The mean (SD) intensive care unit stay was 2.11 (1.12) days and 1.45 (0.71) days (P = .033), and the hospital stay was 7.32 (1.44) days and 6.22 (0.45) days in groups 1 and 2, respectively (P = .027). Conclusion The data in this study suggest that an additional graft on the RV branch of the RCA (eg, conus, marginal, any good runoff vessels on the RV) prevents severe RV dysfunction and allows for rapid recovery of RV dysfunction after off-pump coronary surgery.

Is right ventricular free wall revascularization underrated? Sequential bypass of mid-right coronary artery to resolve acute right ventricular dysfunction

“…Complete revascularization of extensive RCA disease by bypassing marginal branches, with sequential or separate grafts, has been studied by Turkish groups. 2 , 3 , 4 In these studies, addressing RV free wall ischemia was shown to prevent RV dysfunction and perioperative ischemic events after CABG, especially in patients with left ventricular dysfunction. In the early postoperative period, myocardial protection is commonly blamed for RV dysfunction.…”

Perspective Chapter: Right Ventricular Free Wall – The Forgotten Territory for Revascularization

“…Multiple surgical groups from Turkey have adopted the concept of RV-free wall revascularization and studied the impact on clinical outcomes [8][9][10]. In a prospective Coronary Artery Bypass Surgery -New Insights randomized study, Güney and Eren compared complete RV revascularization with multiple bypasses to RCA branches (n = 32 patients) to a single conventional bypass to RCA (n = 32 patients) [9].…”

“…In another study of 35 patients with diffuse atherosclerotic disease of the RCA who underwent CABG; RV diastolic function by echocardiography improved in 20 patients with sequential bypass to RCA compared to 15 patients with single bypass to RCA [10]. In another comparative analysis conducted by Sahin et al, 100 patients with multi-segments disease of the RCA underwent off-pump CABG, in which 50 patients had single bypass to distal RCA and 50 patients had additional bypass to marginal branch of RCA [8]. Patients who had additional bypass to the RV branch experienced faster recovery of RV function, less inotropic support, and shorter hospitalization than the group with single distal RCA bypass.…”

“…Several studies have reported the persistence of RV dysfunction later after CABG during follow-up [4][5][6][7]. Moreover, other studies have shown that RV-free wall revascularization prevented postoperative RV dysfunction and peri-operative ischemic complications [8][9][10]. In this article, we aim to examine the available relevant evidence to address the question of how important RV-free wall revascularization during CABG is.…”