Right Ventricular Function After Coronary Surgery with or Without Bypass

Durand, M.; Chavanon, Olivier; Tessier, Yannick; Casez, Myriam; Gardellin, M.; Blin, Dominique; P, Girardet

doi:10.1111/j.1540-8191.2006.00161.x

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…This contrasts with the findings of Durand et al, 16 who, using thermodilution catheters to calculate ejection fraction, reported a significant fall in RVEF associated with the ONCABG technique compared with OPCABG in patients with a significant stenosis of the RCA. 16 However, there are several reasons to possibly explain these discrepant findings. First, the study by Durand et al 16 was not randomized, and the operations were performed by different …”

Section: Effect Of Opcabg Surgery and Rca Disease On Early Rv Functioncontrasting

confidence: 56%

“…Furthermore, thermodilution catheters derive the ejection fraction on the basis of flow rather than volume, and although potentially useful for serial measurements in an individual patient, there are no data on reproducibility. Furthermore, in contrast to the present study, Durand et al 16 examined only patients with Ͼ90% RCA stenosis who all had grafts placed in the RCA territory.…”

Section: Pegg Et Al Effect Of Opcabg/oncabg On Rv Function 2207mentioning

confidence: 61%

“…16 However, there are several reasons to possibly explain these discrepant findings. First, the study by Durand et al 16 was not randomized, and the operations were performed by different …”

Section: Effect Of Opcabg Surgery and Rca Disease On Early Rv Functionmentioning

confidence: 71%

“…Studies that used thermodilution catheters placed in the pulmonary artery to assess RV function also produced inconsistent results between the different surgical techniques (Table 6). 15,16,24 …”

Section: Comparative Studiesmentioning

confidence: 99%

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Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting on Early and Late Right Ventricular Function

et al. 2008

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Background-Off-pump CABG (OPCABG) results in better preservation of left ventricular function in the perioperative period than conventional on-pump CABG (ONCABG); however, evidence is conflicting as to the effect of OPCABG and ONCABG on right ventricular (RV) function, possibly because of the complexity involved in measuring this. Methods and Results-In a single-center randomized pilot study, 60 patients with normal left ventricular function undergoing CABG were randomly assigned to OPCABG or ONCABG. Patients underwent cardiac magnetic resonance imagine for assessment of RV function preoperatively, early postoperatively, and at 6 months after surgery. Fifty-one patients completed the first 2 scans, and 47 completed all 3 scans. Preoperative characteristics and RV function did not differ significantly between the 2 groups (meanϮSD): RV stroke volume index was 49Ϯ10 mL/m 2 for OPCABG and 49Ϯ16 mL/m 2 for ONCABG. After surgery, RV stroke volume index fell to 36Ϯ7 mL/m 2 in the OPCABG group and 39Ϯ11 mL/m 2 in the ONCABG group, but this did not differ significantly between the 2 groups (Pϭ0.41). All markers of RV function recovered to preoperative levels by 6 months, with no long-term difference between the surgical techniques. Conclusions-RV function is impaired early after surgery but recovers by 6 months. The changes were similar in both the OPCABG and ONCABG groups.

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Section: Effect Of Opcabg Surgery and Rca Disease On Early Rv Functioncontrasting

confidence: 56%

Section: Pegg Et Al Effect Of Opcabg/oncabg On Rv Function 2207mentioning

confidence: 61%

Section: Effect Of Opcabg Surgery and Rca Disease On Early Rv Functionmentioning

confidence: 71%

Section: Comparative Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting on Early and Late Right Ventricular Function

et al. 2008

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“…14 This latter theory can be tested by comparing RV function in patients receiving OPCAB versus those receiving conventional CABG. 10,15 In this issue of Circulation, Pegg et al report on the impact of CPB on RV function as measured by cardiac magnetic resonance imaging (CMRI). 16 Right ventricular function has been notoriously difficult to assess in the postoperative setting.…”

Section: Article P 2202mentioning

confidence: 99%

Can the Off-Pump Coronary Artery Bypass Debate Shed Light on Postoperative Right Heart Dysfunction?

Davidson

2008

Circulation

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he debate over the relative merits of off-pump coronary artery bypass grafting (OPCAB) and conventional onpump coronary artery bypass grafting (CABG) continues unabated and remains an area of great controversy. Given the known effects of cardiopulmonary bypass (CPB) on the inflammatory and coagulation cascades, as well as a suggestion of adverse neurological sequelae, there has been a logical argument to perform surgical revascularizations without its use. Proponents of OPCAB have cited advantages in terms of neurological outcomes, renal function, blood use, cost, length of stay, arrhythmias, infections, and ventricular function. [1][2][3] Critics assert that OPCAB is more technically demanding than conventional CABG, and, moreover, that consistent data showing sustained benefits have been lacking and that some existing data suggest inferior revascularization. 4,5 At present, analyses of randomized controlled trials have generally shown that OPCAB results in outcomes equivalent to those of conventional CABG in terms of mortality, long-term neurological function, and revascularization while reducing rates of blood use, renal impairment, and cost. 3,6 -8 Given the steep learning curve of OPCAB and lack of clear long-term cardiovascular or neurological benefit, however, many surgeons have reverted to or continued to favor conventional CABG as their strategy of choice. One criticism leveled at OPCAB is that the results reported usually come from surgeons and centers that are exceptionally experienced in the technique. Given the significantly higher technical demands of OPCAB, results equivalent to conventional CABG may not be applicable to most practicing surgeons. The implication, though unproven, is that the average cardiac surgeon might experience worse outcomes when using OPCAB than with conventional CABG. Indeed, this may explain the relatively low penetration of this technique, despite some demonstrable advantages. Thus, despite high expectations and initial enthusiasm for OPCAB, only about 20% to 25% of surgical coronary revascularizations in the United States are currently performed without the use of CPB. Article p 2202Entered into this fray is the impact of CPB on right ventricular (RV) function. For reasons that have not been elucidated, cardiac surgery appears to result in functional changes in the right ventricle, perhaps related to the nearly universally observed postoperative paradoxical septal motion. 9 -12 Some investigators have suggested that the changes are attributable to the pericardiotomy, with its accompanying effects on RV function. 13 Other studies have suggested a relationship between the use of cardiopulmonary bypass and/or cardioplegic arrest and postoperative RV dysfunction. 14 This latter theory can be tested by comparing RV function in patients receiving OPCAB versus those receiving conventional CABG. 10,15 In this issue of Circulation, Pegg et al report on the impact of CPB on RV function as measured by cardiac magnetic resonance imaging (CMRI). 16 Right ventricular function has bee...

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Right ventricular function after coronary artery bypass graft surgery—a magnetic resonance imaging study

Joshi

Roswell

Salah

et al. 2010

Cardiovascular Revascularization Medicine

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Right Ventricular Function After Coronary Surgery with or Without Bypass

Abstract: In patients with severe right coronary stenosis, off-pump cardiac surgery seemed to provide better right ventricular protection.

Cited by 5 publications

References 22 publications

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting on Early and Late Right Ventricular Function

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting on Early and Late Right Ventricular Function

Can the Off-Pump Coronary Artery Bypass Debate Shed Light on Postoperative Right Heart Dysfunction?

Right ventricular function after coronary artery bypass graft surgery—a magnetic resonance imaging study

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