CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
AFRICA
63
Cardiovascular Topics
Effect of sequential coronary artery bypass venous
grafting on right ventricular functions assessed by
tissue Doppler echocardiography
G OZERDEM, N KATRANCIOGLU, B CANDEMIR, E SARICAM, O OZTURK, O BERKAN
Abstract
Background:
Coronary artery bypass graft surgery is a
well-known and proven method of treatment for coronary
artery disease. A modification of this method is complete
revascularisation of the right ventricle by sequential bypass
grafting of the right coronary artery, the effects of which
on ventricular function need to be clarified. We sought to
determine the effect of the sequential bypass graft method
on right ventricular (RV) function utilising tissue Doppler
echocardiography.
Methods:
A total of 35 coronary artery disease patients
(groupA: 20 sequential grafts; group B: 15 individual grafts)
were enrolled. Patients were examined pre-operatively with
tissue Doppler echocardiography for RV function, and again
postoperatively after the first month.
Results:
Pre-operatively, there were no significant differences
with regard to demographics or basal echocardiographic
findings. On the other hand, postoperative right ventricular
diastolic function was found to have improved significantly
as the right ventricular E wave and E/A increased (9.5
±
1.6
vs 7.6
±
2.7 cm/s,
p
= 0.009 and 1.4
±
0.2 vs 0.9
±
0.2,
p
≤
0.01,
respectively), while the A wave and isovolumic relaxation
times (6.8
±
2.1 vs 8.3
±
3.4 cm/s,
p
<
0.03 and 55.2
±
11.9 vs
87.2
±
16.2 ms,
p
<
0.001, respectively) decreased. Although
the S-wave peak amplitude decreased in group A patients, it
did not reach statistical significance.
Conclusions:
Sequential, but not single, complete revasculari-
sation of the right coronary artery appeared to improve the
diastolic function of the right ventricle.
Keywords:
sequential bypass grafting, right ventricle, echocar-
diography, diastolic function, coronary artery disease
Submitted 29/3/10, accepted 26/11/10
Cardiovasc J Afr
2012;
23
: 63–66
DOI: 10.5830/CVJA-2010-093
Coronary artery bypass graft surgery (CABG) is a well-known
and proven method for myocardial revascularisation. The tech-
nique used (individual or sequential grafting) may be of impor-
tance with regard to long-term patency of these conduits.
1
Saphenous vein grafts (SVGs) are still widely used but this
is often limited to revascularisation of one tributary coronary
vessel, and to situations in which a high starting flow is desir-
able immediately. On the other hand, use of sequential grafting
of multiple coronary vessels in CABG surgery has been contro-
versial since its introduction by Flemma
2
and its amplification
by Bartley,
3
who suggested it to be the most extensive way of
myocardial revascularisation.
The technical advantages of the sequential grafting method are
the economical use of graft material and the decreased number
of proximal anastomoses,
4-7
as well as haemodynamic benefits.
5,8,9
Although the effect of CABG on right ventricular (RV) function
has been clearly demonstrated, the effect of sequential grafting of
the right coronary artery remains to be clarified.
In this study we aimed to determine the effects of complete
revascularisation of the right coronary artery (RCA) via sequen-
tial venous bypass grafting on the RV diastolic function as deter-
mined by tissue Doppler echocardiography.
Methods
The study was approved by the local ethics committee and all
subjects gave informed consent. Thirty-five (19 men and 16
women) consecutive patients undergoing CABG between 2006
and 2009 were enrolled into this prospective study. Group A
(
n
=
20) included patients who had sequential right coronary
artery bypass and group B (
n
=
15) included the remainder who
could not have sequential bypass due to anatomical or techni-
cal reasons. All patients had significant coronary artery disease
(CAD) and were accepted for CABG within two months of the
diagnostic coronary angiography. Transthoracic echocardiogra-
phy was performed before the CABG operation.
Patients who had isolated coronary artery disease not associ-
ated with any other cardiac pathology and who had a left ventric-
Department of Cardiovascular Surgery, Cag Hospital,
Ankara, Turkey
G OZERDEM, MD
Department of Cardiovascular Surgery, Cumhuriyet
University School of Medicine, Sivas, Turkey
N KATRANCIOGLU, MD,
O BERKAN, MD
Department of Cardiology, Ankara University School of
Medicine, Ankara, Turkey
B CANDEMIR, MD
Department of Cardiology, Cag Hospital, Ankara, Turkey
E SARICAM, MD
O OZTURK, MD
