title: Limits of arterial myocardial revascularization.
abstract: A prospective study of myocardial blood perfusion after coronary artery bypass graft (CABG) was conducted in two groups of patients. In group 1, a two-year assessment by exercise thallium myocardial scintigraphy without medical treatment was performed in 122 patients who consecutively underwent CABG with exclusive use of both internal mammary arteries (IMA) and gastroepiploic artery (GEA). In group 2, myocardial function and perfusion were determined by radionuclide investigations performed before and one year after CABG in 100 patients with preoperative LV dysfunction (defined as LV ejection fraction (LVEF) less than 0.40), comparing results of myocardial revascularization performed with either exclusive arterial grafts (arterial group, 54 patients) or one arterial graft (IMA) associated with a sequential vein graft (vein group, 46 patients). In group 1, 21% of patients presented silent residual electric ischemia during exercise stress testing and 26% had reversible scintigraphic ischemic defect despite complete revascularization, 18% of those in the inferior wall bypassed with GEA and 8% in the anterior wall bypassed with the right IMA. In group 2, the significant preoperative ischemia significantly decreased in both the vein group and the arterial group. LV function was significantly improved in the vein group; in contrast there was no modification of LV function in the arterial group. A multivariate analysis showed that the surgical technique used and the preoperative LVEF were independent prognostic factors of the postoperative myocardial outcome, with a positive impact of the vein use on the postoperative myocardial function recovery. It is important to recognize that arterial grafts have some limitations in the ability to supply blood flow for coronary circulation that may induce postoperatively silent residual myocardial ischemia and a lack of LV function recovery.
authors.affiliation: Department of Cardiac Surgery, Louis Pradel Hospital, Claude Bernard University, Lyon, France. ojegaden@compuserve.com
authors.forename: Olivier
authors.initials: O
authors.lastname: Jegaden
authors.forename: Guy
authors.initials: G
authors.lastname: de Gevigney
authors.forename: Fadi
authors.initials: F
authors.lastname: Farhat
authors.forename: Zhiqian
authors.initials: Z
authors.lastname: Lu
authors.forename: Pietro
authors.initials: P
authors.lastname: Montagna
authors.forename: Roland
authors.initials: R
authors.lastname: Itti
authors.forename: Philippe
authors.initials: P
authors.lastname: Mikaeloff
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods; D011184:Postoperative Period; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D018570:Risk Assessment; D013794:Thallium Radioisotopes; D016896:Treatment Outcome
chemical_list: D013794:Thallium Radioisotopes