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Ann Thorac Surg 1994;58:857-863
© 1994 The Society of Thoracic Surgeons

Articles

Left ventricular function and coronary artery disease progression early after coronary bypass grafting

Dimitris Tousoulis, MD, Graham Davies, FRCP, Tom Crake, MD, Sunil K. Ohri, FRCS, Parachuri Rao, FRCS, Kenneth M. Taylor, FRCS*

Cardiothoracic and Cardiology Units, Royal Postgraduate Medical School, Hammersmith Hospital, London, England

Accepted for publication February 12, 1994.

* Address reprint requests to Dr Taylor, Cardiothoracic Unit, Hammersmith Hospital, Ducane Rd, London W12 ONN, England.

To investigate the effects of coronary artery disease progression on left ventricular function in patients who suffer angina early after coronary artery bypass grafting, we studied the progression of coronary stenoses, the occurrence of graft occlusions, and measured left ventricular ejection fraction (regional and global) in 34 consecutive patients who underwent repeat angiography 25.2 ± 3.5 (standard error of the mean) months postoperatively, from a total population of 550 patients who underwent bypass grafting. Resting left ventricular function and stenosis severity were assessed using a computerized, quantitative analysis system. Coronary stenosis progression was defined as an increase in the percentage of the stenotic occlusion by 30% or more, any increase in lesion severity that resulted in total coronary antery occlusion, or the occurrence of a new stenosis that occluded the artery by 50% or more. Group 1 comprised 21 patients with all grafts patent and group 2 comprised 13 patients with one or more grafts occluded (20 of 34 grafts). Coronary artery disease progressed in all patients in group 1, and this involved 22 of 54 (41%) grafted vessels and 3 of 15 (20%) nongrafted vessels (p < 0.05). Coronary artery disease progressed in 11 patients in group 2, involving 15 of 32 (47%) grafted vessels and 1 of 6 (17%) nongrafted vessels (p < 0.01). An increased collateral circulation was observed in both groups. The left ventricular ejection fraction remained unchanged in both groups (group 1, 0.60 ± 0.03 versus 0.62 ± 0.03; group 2, 0.62 ± 0.05 versus 0.62 ± 0.04 before and after bypass, respectively; p = not significant) and there was no difference between the groups. We conclude from our findings that, in patients with angina that recurs within 5 years of the bypass procedure, left ventricular function is preserved despite coronary artery disease progression and graft occlusion. This is probably due to the development of a collateral circulation, albeit insufficient to prevent exercise-induced myocardial ischemia.






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