A comparative study of total arterial coronary revascularization in patients with left ventricular dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HUANG Derong , FENG Yi , WENG Qing , LIAO Yuanfeng , LUO Gang , LIU Daxing

Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical University, zunyi 563000, china;

Corresponding author：

HUANG Derong, Email: 18798105417@163.com

Keywords：

Coronary artery bypass graft; coronary artery disease; total arterial revascularization; left ventricular dysfunction

DOI：

10.7507/1007-4848.202303055

Video：

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Objective To compare the superiority of total arterial revascularization in patients with coronary artery disease (CAD) complicated with left ventricular dysfunction. Methods This retrospective study included the patients who were diagnosed with CAD with the left ventricular ejection fraction (LVEF) of ≤ 40% and underwent coronary artery bypass grafting (CABG) at our hospital from January 2016 to July 2019. The data related to perioperative and postoperative follow-up were collected. The patients were divided into two groups according to the different types of bypass vessels: a total arterialization group (TAR group) and a conventional group. A wealth of clinical data were reviewed and compared between the two groups to explore the incidence of important complications and evaluate the safety of total arterial revascularization and its protective effect on cardiac function. Results Finally 75 patients were enrolled including 52 males and 23 females with a mean age of 61.58±7.93. The operation time and the drainage volume of 24 hours after operation in the TAR group were longer or more than those in the conventional group (P<0.05), but there was no statistical difference in hospital stay, postoperative complications (such as respiratory failure, mediastinal infection, renal failure), IABP or ECMO auxiliary rate (P>0.05). After 2 years of follow-up, compared with the conventional group, the cardiac function of the TAR group was significantly improved (P<0.05), the LVEF was higher (P<0.05), the left ventricular end diastolic diameter (LVEED) was reduced (P<0.05), and the bridge stenosis rate was lower (P<0.05). Conclusion Total arterial revascularization is a safe and feasible surgical method, which is helpful to improve the cardiac function and improve the quality of life.

1.	Gaudino M, Bakaeen FG, Benedetto U, et al. Arterial grafts for coronary bypass: A critical review after the publication of ART and RADIAL. Circulation, 2019, 140(15): 1273-1284.
2.	宋媛媛, 徐骁晗, 陆小虎, 等. 个体化全动脉冠状动脉旁路移植术的临床应用. 南京医科大学学报(自然科学版), 2019, 39(6): 899-902.
3.	Gaudino M, Tondi P, Benedetto U, et al. Radial artery as a coronary artery bypass conduit: 20-year results. J Am Coll Cardiol, 2016, 68(6): 603-610.
4.	Benedetto U, Gaudino M, Ng C, et al. Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. Int J Cardiol, 2016, 210: 19-24.
5.	孙勇新, 丁文军, 夏利民, 等. 全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用. 中华医学杂志, 2019, 99(14): 1058-1062.
6.	Amin S, Madsen PL, Werner RS, et al. Intraoperative flow profiles of arterial and venous bypass grafts to the left coronary territory. Eur J Cardiothorac Surg, 2019, 56(1): 64-71.
7.	高熠洲, 陆小虎, 徐骁晗, 等. 全动脉化与单根动脉冠状动脉搭桥围手术期疗效对比研究. 南京医科大学学报(自然科学版), 2021, 41(6): 885-888.
8.	Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med, 2018, 378(22): 2069-2077.
9.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
10.	严哲, 张小涛, 李晓恒. 全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用价值. 中国实用医刊, 2022, 49(9): 18-21.
11.	Buttar SN, Yan TD, Taggart DP, et al. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: A meta-analysis. Heart, 2017, 103(18): 1419-1426.
12.	Mastrobuoni S, Gawad N, Price J, et al. Use of bilateral internal thoracic artery during coronary artery bypass graft surgery in Canada: The bilateral internal thoracic artery survey. J Thorac Cardiovasc Surg, 2012, 144(4): 874-879.
13.	Benedetto U, Altman DG, Gerry S, et al. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg, 2016, 152(1): 270-276.
14.	Iddawela S, Mellor SL, Zahra SA, et al. Pedicled or skeletonized bilateral internal mammary artery harvesting - A meta-analysis and trial sequential analysis. Expert Rev Cardiovasc Ther, 2021, 19(7): 647-654.
15.	Schwann TA, Habib RH, Wallace A, et al. Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting. Ann Thorac Surg, 2018, 105(4): 1109-1119.
16.	Gaudino M, Lorusso R, Rahouma M, et al. Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A network meta-analysis of clinical outcomes. J Am Heart Assoc, 2019, 8(2): e010839.
17.	Gaudino MFL, Taggart DP, Fremes SE. The ROMA trial: Why it is needed. Curr Opin Cardiol, 2018, 33(6): 622-626.
18.	Di Bacco L, Repossini A, Muneretto C, et al. Long-term outcome of total arterial myocardial revascularization versus conventional coronary artery bypass in diabetic and non-diabetic patients: A propensity-match analysis. Cardiovasc Revasc Med, 2020, 21(5): 580-587.
19.	Liu DX, Chen XJ, Zheng BS, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: A multi-center retrospective study. Zhonghua Yi Xue Za Zhi, 2020, 100(18): 1390-1395.

1. Gaudino M, Bakaeen FG, Benedetto U, et al. Arterial grafts for coronary bypass: A critical review after the publication of ART and RADIAL. Circulation, 2019, 140(15): 1273-1284.
2. 宋媛媛, 徐骁晗, 陆小虎, 等. 个体化全动脉冠状动脉旁路移植术的临床应用. 南京医科大学学报(自然科学版), 2019, 39(6): 899-902.
3. Gaudino M, Tondi P, Benedetto U, et al. Radial artery as a coronary artery bypass conduit: 20-year results. J Am Coll Cardiol, 2016, 68(6): 603-610.
4. Benedetto U, Gaudino M, Ng C, et al. Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. Int J Cardiol, 2016, 210: 19-24.
5. 孙勇新, 丁文军, 夏利民, 等. 全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用. 中华医学杂志, 2019, 99(14): 1058-1062.
6. Amin S, Madsen PL, Werner RS, et al. Intraoperative flow profiles of arterial and venous bypass grafts to the left coronary territory. Eur J Cardiothorac Surg, 2019, 56(1): 64-71.
7. 高熠洲, 陆小虎, 徐骁晗, 等. 全动脉化与单根动脉冠状动脉搭桥围手术期疗效对比研究. 南京医科大学学报(自然科学版), 2021, 41(6): 885-888.
8. Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med, 2018, 378(22): 2069-2077.
9. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
10. 严哲, 张小涛, 李晓恒. 全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用价值. 中国实用医刊, 2022, 49(9): 18-21.
11. Buttar SN, Yan TD, Taggart DP, et al. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: A meta-analysis. Heart, 2017, 103(18): 1419-1426.
12. Mastrobuoni S, Gawad N, Price J, et al. Use of bilateral internal thoracic artery during coronary artery bypass graft surgery in Canada: The bilateral internal thoracic artery survey. J Thorac Cardiovasc Surg, 2012, 144(4): 874-879.
13. Benedetto U, Altman DG, Gerry S, et al. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg, 2016, 152(1): 270-276.
14. Iddawela S, Mellor SL, Zahra SA, et al. Pedicled or skeletonized bilateral internal mammary artery harvesting - A meta-analysis and trial sequential analysis. Expert Rev Cardiovasc Ther, 2021, 19(7): 647-654.
15. Schwann TA, Habib RH, Wallace A, et al. Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting. Ann Thorac Surg, 2018, 105(4): 1109-1119.
16. Gaudino M, Lorusso R, Rahouma M, et al. Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A network meta-analysis of clinical outcomes. J Am Heart Assoc, 2019, 8(2): e010839.
17. Gaudino MFL, Taggart DP, Fremes SE. The ROMA trial: Why it is needed. Curr Opin Cardiol, 2018, 33(6): 622-626.
18. Di Bacco L, Repossini A, Muneretto C, et al. Long-term outcome of total arterial myocardial revascularization versus conventional coronary artery bypass in diabetic and non-diabetic patients: A propensity-match analysis. Cardiovasc Revasc Med, 2020, 21(5): 580-587.
19. Liu DX, Chen XJ, Zheng BS, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: A multi-center retrospective study. Zhonghua Yi Xue Za Zhi, 2020, 100(18): 1390-1395.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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