Total arterial revascularization for patients with coronary artery disease and left ventricular dysfunction: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

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

Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, P. R. China;

Corresponding?author：

HUANG Derong, Email: 18798105417@163.com

Keywords：

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

DOI：

10.7507/1007-4848.202303055

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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 and 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 patients were divided into two groups according to the different types of bypass vessels: a total arterial revascularization group (TAR group) and a conventional group (a CON group). The clinical data were 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) years. There were 35 patients in the TAR group and 40 patients in the CON group. The operation time and the drainage volume at 24 hours after operation in the TAR group were longer or more than those in the CON group (P<0.001), but there was no statistical difference in hospital stay, postoperative complications (such as respiratory failure, mediastinal infection, renal failure), intra-aortic balloon pump or extracorporeal membrane oxygenation use rate (P>0.05). After 2 years of follow-up, compared with the CON group, the cardiac function of the TAR group was significantly improved, the LVEF was higher, the left ventricular end diastolic diameter was reduced, and the graft stenosis rate was lower (all 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.

Citation： HUANG Derong, FENG Yi, WEN Qing, LIAO Yuanfeng, LUO Gang, LIU Daxing. Total arterial revascularization for patients with coronary artery disease and left ventricular dysfunction: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1826-1831. doi: 10.7507/1007-4848.202303055 Copy

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, 徐驍晗, 陸小虎, 等. 個體化全動脈冠狀動脈旁路移植術的臨床應用. 南京醫科大學學報(自然科學版), 2019, 39(6): 899-902.Song YY, Xu XH, Lu XH, et al. Clinical application of individualized whole-artery coronary artery bypass grafting. J Nanjing Med Univ (Natural Sciences), 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.	孫勇新, 丁文軍, 夏利民, 等. 全動脈化冠狀動脈旁路移植術在左心室功能低下患者中的應用. 中華醫學雜志, 2019, 99(14): 1058-1062.Sun YX, Ding WJ, Xia LM, et al. Clinical outcomes of total arterial off-pump coronary revascularization in patients with left ventricular dysfunction. Natl Med J China, 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, 陸小虎, 徐驍晗, 等. 全動脈化與單根動脈冠狀動脈搭橋圍手術期療效對比研究. 南京醫科大學學報(自然科學版), 2021, 41(6): 885-888.Gao YZ, Lu XH, Xu XH, et al. Comparative study of perioperative effect of total arterialization and single artery coronary artery bypass grafting. J Nanjing Med Univ (Natural Sciences), 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.	嚴哲, 張小濤, 李曉恒. 全動脈化冠狀動脈旁路移植術在左心室功能低下患者中的應用價值. 中國實用醫刊, 2022, 49(9): 18-21.Yan Z, Zhang XT, Li XH, et al. Application value of total arterial revascularization combined with coronary bypass grafting in patients with left ventricular dysfunction. Chin Pract Med, 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.	劉達興, 陳緒軍, 鄭寶石, 等. 體外循環下全動脈冠狀動脈旁路移植治療左室功能低下冠心病多中心臨床觀察. 中華醫學雜志, 2020, 100(18): 1390-1395.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. Natl Med J China, 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, 徐驍晗, 陸小虎, 等. 個體化全動脈冠狀動脈旁路移植術的臨床應用. 南京醫科大學學報(自然科學版), 2019, 39(6): 899-902.Song YY, Xu XH, Lu XH, et al. Clinical application of individualized whole-artery coronary artery bypass grafting. J Nanjing Med Univ (Natural Sciences), 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. 孫勇新, 丁文軍, 夏利民, 等. 全動脈化冠狀動脈旁路移植術在左心室功能低下患者中的應用. 中華醫學雜志, 2019, 99(14): 1058-1062.Sun YX, Ding WJ, Xia LM, et al. Clinical outcomes of total arterial off-pump coronary revascularization in patients with left ventricular dysfunction. Natl Med J China, 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, 陸小虎, 徐驍晗, 等. 全動脈化與單根動脈冠狀動脈搭橋圍手術期療效對比研究. 南京醫科大學學報(自然科學版), 2021, 41(6): 885-888.Gao YZ, Lu XH, Xu XH, et al. Comparative study of perioperative effect of total arterialization and single artery coronary artery bypass grafting. J Nanjing Med Univ (Natural Sciences), 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. 嚴哲, 張小濤, 李曉恒. 全動脈化冠狀動脈旁路移植術在左心室功能低下患者中的應用價值. 中國實用醫刊, 2022, 49(9): 18-21.Yan Z, Zhang XT, Li XH, et al. Application value of total arterial revascularization combined with coronary bypass grafting in patients with left ventricular dysfunction. Chin Pract Med, 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. 劉達興, 陳緒軍, 鄭寶石, 等. 體外循環下全動脈冠狀動脈旁路移植治療左室功能低下冠心病多中心臨床觀察. 中華醫學雜志, 2020, 100(18): 1390-1395.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. Natl Med J China, 2020, 100(18): 1390-1395.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Total arterial revascularization for patients with coronary artery disease and left ventricular dysfunction: A retrospective cohort study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content