Sağ ventrikül dalına ek bypass greftlemenin elektrokardiyografik ve ekokardiyografik parametreler üzerindeki etkisi

Abstract

Amaç: Bu çalışma, sağ ventrikül (SV) dallarına ek koroner arter bypass greftleme (KABG) işleminin ekokardiyografik ve elektrokardiyografik parametreler üzerindeki etkisini, özellikle SV fonksiyonu ve elektriksel stabiliteye odaklanarak değerlendirmeyi amaçladı. Gereç ve Yöntemler: Ocak 2017 ile Aralık 2022 tarihleri arasında belirgin sağ koroner arter (SKA) hastalığı nedeniyle KABG uygulanan hastalar retrospektif olarak incelendi. Hastalar dahil edilerek iki gruba ayrıldı: Grup 1 (n = 34), sadece distal RCA dallarına (posterior desendan arter veya posterolateral dal) greft uygulanan hastaları içerirken, Grup 2 (n = 34), hem distal SKA hem de SV dalına greft uygulanan hastaları içeriyordu. Gruplar arasında ameliyat öncesi ve taburculuk dönemindeki ekokardiyografik ve elektrokardiyografik parametreler karşılaştırıldı. Bulgular: Gruplar arasında başlangıçta ekokardiyografik ve elektrokardiyografik parametreler dahil olmak üzere temel özellikler açısından fark bulunmamaktaydı. Taburculuk döneminde, triküspit anüler düzlem sistolik ekskürsiyonu (TAPSE) değeri Grup 1’de Grup 2’ye kıyasla daha düşüktü (11.7 ± 2.7 mm vs. 15.1 ± 2.3 mm; p < 0.001). Diyastolik disfonksiyon oranı Grup 1’de Grup 2’ye göre daha yüksekti (%91.2 vs. %61.8; p < 0.001). Ortalama QT dispersiyonu (54.6 ± 15.4 ms vs. 63.7 ± 18.5 ms; p = 0.031) ve ortalama P dalgası dispersiyonu (22.5 ± 5.3 ms vs. 26.2 ± 8.8 ms; p = 0.048) değerleri Grup 2’de Grup 1’e kıyasla daha düşüktü. Sonuçlar: Belirgin RCA hastalığı olan hastalarda RV dalına ek bypass greftleme, SV fonksiyonlarında iyileşme ve daha olumlu elektrokardiyografik parametrelerle ilişkilendirildi.

Keywords

• Koroner arter bypass greftleme
• P dalgası dispersiyonu
• sağ ventrikül fonksiyonu
• sağ koroner arter
• ventriküler repolarizasyon
• triküspit anüler düzlem sistolik ekskürsiyonu

The impact of additional right ventricular branch grafting on electrocardiographic and echocardiographic parameters

Abstract

Aims: This study aimed to evaluate the impact of additional coronary artery bypass grafting (CABG) to right ventricular (RV) branches on echocardiographic and electrocardiographic parameters, with a focus on RV function and electrical stability. Methods: A retrospective review was conducted on patients who underwent CABG with significant right coronary artery (RCA) disease between January 2017 and December 2022. Patients were included and divided into two groups: Group 1 (n = 34) received grafts only to the distal RCA branches (posterior descending artery or posterolateral branch); Group 2 (n = 34) underwent grafting to both the distal RCA and the RV branch. Preoperative and discharge periods, echocardiographic and electrocardiographic parameters were compared between groups. Results: Both groups had comparable baseline characteristics, including echocardiographic and electrocardiographic parameters. At discharge, tricuspid annular plane systolic excursion (TAPSE) was lower in Group 1 compared to Group 2 (11.7 ± 2.7 mm vs. 15.1 ± 2.3 mm; p < 0.001). The ratio of diastolic dysfunction was higher in Group 1 compared to Group 2 (91.2% vs. 61.8%; p < 0.001). The mean QT dispersion (54.6 ± 15.4 ms vs. 63.7 ± 18.5 ms; p = 0.031) and mean P wave dispersion (22.5 ± 5.3 ms vs. 26.2 ± 8.8 ms; p = 0.048) levels were lower in Group 2 compared to Group 1. Conclusion: Additional bypass grafting of the RV branch in patients with significant RCA disease was associated with improved RV function and more favorable electrocardiographic parameters.

Keywords

• Coronary artery bypass grafting
• P-wave dispersion
• right ventricular function
• right coronary artery
• ventricular repolarization
• TAPSE
• transannular plane systolic excursion

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Lokman Hekim University Non-Interventional Clinical Research Ethics Committee (Date: 23.12.2021, Decision No: 2021/158).

References

1. Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, and Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol. 2016;8(6):537-55.
2. ElGuindy MS and ElGuindy AM. Aneurysmal coronary artery disease: An overview. Glob Cardiol Sci Pract. 2017;2017(3):e201726.
3. Kamel WA, Zarif B, and Elhendawy SAK. Saphenous Vein Graft Patency When Anastomosed to Distal Right Coronary Artery versus Right Posterior Descending Artery: A Comparative Study. The Egyptian Journal of Hospital Medicine. 2022;87(1):2269-74.
4. Zhao Z, Fu C, Zhang LX, Zhang GD, and Chen Y. Perioperative observations of different bypass modes of a right coronary system based on instantaneous blood flow during the operation. J Cardiothorac Surg. 2020;15(1):217.
5. Savas G, Yazici S, and Terzi S. A proximal right coronary artery occlusion presenting with ST-segment depression in leads II, III, and aVF. Anatol J Cardiol. 2020;24(6):411-14.
6. Ali Sahin M, Yokusoglu M, Kuralay E, and Ozal E. Can Right Ventricular Branch Bypass Alleviate Right Ventricular Dysfunction? Tex Heart Inst J. 2022;49(5):e217607.
7. Ozerdem G, Katrancioglu N, Candemir B, Saricam E, Ozturk O, and Berkan O. Effect of sequential coronary artery bypass venous grafting on right ventricular functions assessed by tissue Doppler echocardiography. Cardiovasc J Afr. 2012;23(2):63-6.
8. Umana Pizano JB, Arain FD, Harb SC, Bakaeen FG, and Elgharably H. Is right ventricular free wall revascularization underrated? Sequential bypass of mid-right coronary artery to resolve acute right ventricular dysfunction. JTCVS Tech. 2023;21:118-21.

9. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713; quiz 86-8.
10. Roshanali F, Yousefnia MA, Mandegar MH, Rayatzadeh H, and Alinejad S. Decreased right ventricular function after coronary artery bypass grafting. Tex Heart Inst J. 2008;35(3):250-5.
11. Chinikar M, Rafiee M, Aghajankhah M, et al. Right ventricular dysfunction and associated factors in patients after coronary artery bypass grafting. ARYA Atheroscler. 2019;15(3):99-105.
12. Paparella D, Yau TM, and Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21(2):232-44.
13. Shiraishi M, Kimura N, and Yamaguchi A. Early cardiac contractility outcome of reoperative coronary artery bypass grafting using right gastroepiploic artery. J Card Surg. 2021;36(11):4103-10.
14. Nguyen T, Ngo K, Vu TL, et al. Introducing a Novel Innovative Technique for the Recording and Interpretation of Dynamic Coronary Angiography. Diagnostics (Basel). 2024;14(12)
15. Olearchyk AS. Coronary artery bypass supplemented by grafting of the right ventricular branches. Vascular surgery. 1993;27(7):531-38.
16. Guney MR and Eren E. Revascularization of multiple bypassable extended right coronary arteries. J Thorac Cardiovasc Surg. 2004;127(4):1133-8.
17. Korshin A, Gronlykke L, Nilsson JC, et al. Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study. J Thorac Cardiovasc Surg. 2019;158(2):480-89.
18. Hashemi Jazi M, Amirpour A, Zavvar R, Behjati M, and Gharipour M. Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation. ARYA Atheroscler. 2012;8(2):59-62.
19. Park SJ, Kim HJ, Kim JB, et al. Sequential Versus Individual Saphenous Vein Grafting During Coronary Arterial Bypass Surgery. Ann Thorac Surg. 2020;109(4):1165-73.
20. Hou X, Zhang K, Liu T, et al. The expansion of no-touch harvesting sequential vein graft after off-pump coronary artery bypass grafting. J Card Surg. 2021;36(7):2381-88.
21. Perez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, and Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126-33.