Does the extended used of arterial grafts compromise the myocardial recovery after coronary artery bypass grafting in left ventricular dysfunction?1

Abstract

This study confirms the excellent clinical results of coronary artery bypass grafting (CABG) in patients with coronary artery disease and LV dysfunction; improvement in LV function can be documented objectively and is correlated with reperfusion of hibernating myocardium. However, the extended use of arterial grafts does not allow to achieve the significant myocardial recovery observed with the use of one internal mammary artery (IMA) and associated sequential vein graft; it seems to be related to the preoperative selection of patients, but a direct negative impact of arterial grafts was documented and leads to be cautious in patients with severe LV dysfunction.

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

“…22 The prevalence of Diabetes in our study was 44% in group A and 28% in group B which is higher as compared to prevalence in various studies conducted (LIMA group 22-26% and non-LIMA group 22-50%). 20,22,24 Percentage of patients with hypertension in our study (36%) is similar to the studies conducted by Edwards FH, Jegaden O, Mehsood DK et al (46%, 50%, 42% respectively). 20,22,24 The mean of preoperative LVEF in present study is 44.92±6.82 in A group and 44.28±6.76 in group B while at discharge it is 49.72±5.78in group A and 51.60±5.94 in group B.…”

“…20,22,24 Percentage of patients with hypertension in our study (36%) is similar to the studies conducted by Edwards FH, Jegaden O, Mehsood DK et al (46%, 50%, 42% respectively). 20,22,24 The mean of preoperative LVEF in present study is 44.92±6.82 in A group and 44.28±6.76 in group B while at discharge it is 49.72±5.78in group A and 51.60±5.94 in group B. There was no significant difference in mean preoperative LVEF and LVEF at discharge between the groups (p=0.74, 0.262 respectively).…”

“…They found significant increase in post-operative LV function in venous group. 20 Similar results were also shown in a study by Choudhary AK et al where they demonstrated that at 3 months LV function with total venous conduits had more improvement as compared to mixed conduits. 21 In a study conducted by Edward FH et al majority of patients were in 50-70 years age group with 74% males and 26% females, while in study by Jegadan et al observed mean age of 67 years with 18% females.…”

“…Similar findings were noted by Gaziano TA, that 50% of CHD-related deaths in India occur in people <70 years of age, whereas only 22% of CHD-related deaths in Western countries occur in this age group. 23 The mean BMI (kg/m 2 ) in present study of group A patients was 25 20,24 There were 56% patients in present study who smokers and 44% were alcohol consumers in group A whereas in group B there were 36% and 28% patient respectively who smokes and alcohol (p=0.156 and 0.239 respectively). While 49.66% were smokers in LIMA group and 33.26% in venous group by study conducted by Edwards FH et al (p value <0.005).…”

“…21 In a study conducted by Edward FH et al majority of patients were in 50-70 years age group with 74% males and 26% females, while in study by Jegadan et al observed mean age of 67 years with 18% females. 20,22 In our study mean age was 60 years, with 84% males and 16% females. Lower age group in our study reflects that CHD affects Indians with greater frequency and at a younger age than counterparts in developed countries, as well as many other developing countries.…”