Ann Thorac Surg 1985;39:340-345
© 1985 The Society of Thoracic Surgeons
Improvement in Resting Ventricular Performance Following Coronary Bypass Surgery
Christo I. Tchervenkov, M.D.,
James F. Symes, M.D.,
Allan D. Sniderman, M.D.,
Robert Lisbona, M.D.,
Vilma A. Derbekyan, M.D.,
Richard J. Novick, M.D.,
J. Earl Wynands, M.D.,
Anthony R.C. Dobell, M.D.,
Jean E. Morin, M.D.*
Cardiovascular Research Unit, Royal Victoria Hospital, McGill University, Montreal, PQ, Canada
Accepted for publication July 27, 1984.
* Address reprint requests to Dr. Morin, Division of Cardiovascular Thoracic Surgery, Room S8–30, Royal Victoria Hospital, 687 Pine Ave W, Montreal, PQ, Canada H3A 1A1
To assess the changes in resting left ventricular (LV) function following coronary bypass surgery, technetium 99m–labeled multiple equilibrated blood pool gated scans were performed in 53 consecutive patients at rest, before operation, and at 24 hours and 1 week after operation. Left ventricular ejection fraction (LVEF) and end-diastolic volume (EDV) were measured.
The LVEF increased significantly from a preoperative value of 49 ± 2% to 56 ± 2% at 24 hours after operation (p < 0.05) and 56 ± 2% at 1 week following operation (p < 0.05 compared with the preoperative value). The EDV also exhibited significant changes, decreasing from a preoperative value of 148 ± 8 ml to 91 ± 11 ml at 24 hours (p < 0.001) and 114 ± 9 ml at 1 week (p < 0.01 compared with the preoperative value). When the patients were divided into two groups according to the preoperative LVEF (Group 1, LVEF of greater than or equal to 50%; Group 2, LVEF of less than 50%), the observed changes were similar.
This study demonstrates significant improvement in resting LV function 24 hours following coronary bypass surgery. This improvement persists at 1 week and is not related to the degree of preoperative impairment. We conclude that the combination of successful revascularization and optimal myocardial protection can result in significant improvement of LV function at rest.
Presented at the 56th Scientific Sessions of The American Heart Association, Anaheim, CA, Nov, 1983.
The technical assistance of Dr. Kibe Itiaba is acknowledged.
- Roe BB, Hutchinson JC, Fishman NH, et al. Myocardial protection with cold, ischemic, potassium-induced cardioplegia J Thorac Cardiovasc Surg 1977;73:366.[Abstract]
- Tyers GFO, Manley NJ, Williams EH, et al. Preliminary clinical experience with isotonic, hypothermic potassium-induced arrest J Thorac Cardiovasc Surg 1977;74:674.[Medline]
- Conti VR, Bertranou EG, Blackstone EH, et al. Cold cardioplegia versus hypothermia for myocardial protection: randomized clinical study J Thorac Cardiovasc Surg 1978;76:577.[Abstract]
- Craver JM, Sams AB, Hatcher CR. Potassium-induced cardioplegia: additive protection against ischemic myocardial injury during coronary revascularization J Thorac Cardiovasc Surg 1978;76:24.[Abstract]
- Kent KM, Borer JS, Green MV, et al. Effects of coronary artery bypass on global and regional left ventricular function during exercise N Engl J Med 1978;298:1434.[Medline]
- Newman GE, Rerych SK, Jones RH, Sabiston Jr DC. Noninvasive assessment of the effects of aorta-coronary bypass grafting on ventricular function during rest and exercise J Thorac Cardiovasc Surg 1980;79:617.[Abstract]
- Hellman CK, Kamath ML, Schmidt DH, et al. Improvement in left ventricular function after myocardial revascularization: assessment by first pass rest and exercise nuclear angiography J Thorac Cardiovasc Surg 1980;79:645.[Abstract]
- Lindsay Jr J, Nolan NG, Kotlyarov EV, et al. Radionuclide ventriculography following coronary bypass surgery: correlation with arteriographic findings Ann Thorac Surg 1982;33:238.[Abstract/Free Full Text]
- Austin EH, Oldham Jr HN, Sabiston Jr DC, Jones RH. Early assessment of rest and exercise left ventricular function following coronary artery surgery Ann Thorac Surg 1983;35:159.[Abstract/Free Full Text]
- Roberts AJ, Spies SM, Meyers SN, et al. Early and long-term improvement in left ventricular performance following coronary bypass surgery Surgery 1980;88:467.[Medline]
- Roberts AJ, Spies SM, Sanders JH, et al. Serial assessment of left ventricular performance following coronary artery bypass grafting: early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia J Thorac Cardiovasc Surg 1981;81:69.[Abstract]
- Roberts AJ, Spies SM, Lichtenthal PR, et al. Changes in left ventricular performance related to perioperative myocardial infarction in coronary artery bypass graft surgery Ann Thorac Surg 1983;35:516.[Medline]
- Neumeier D, Prellwitz W, Wurzburg U, et al. Determination of creatine kinase isoenzymes MB activity in serum using immunological inhibition of creatine kinase sub-unit activity: activity kinetics and diagnostic significance in myocardial infarction Clin Chim Acta 1976;73:445.[Medline]
- Ellis RJ, Born M, Feit T, Ebert PA. Potassium cardioplegia: early assessment by radionuclide ventriculography Circulation 1978;58(Suppl 1):57.
- Gray R, Maddahi J, Berman D, et al. Scintigraphic and hemodynamic demonstration of transient left ventricular dysfunction immediately after uncomplicated coronary artery bypass grafting J Thorac Cardiovasc Surg 1979;77:504.[Medline]
- Righetti A, Cramford MH, O'Rourke RA, et al. Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography Am J Cardiol 1977;39:372.[Medline]
- Floyd RD, Sabiston Jr DC, Lee KL, Jones RH. The effect of duration of hypothermic cardioplegia on ventricular function J Thorac Cardiovasc Surg 1983;85:606.[Medline]
- Albogast R, Solignac A, Bourassa MG. Influence of aortocoronary saphenous vein bypass surgery on left ventricular volumes and ejection fraction: comparison before and one year after surgery in 51 patients Am J Med 1973;54:290.[Medline]
- Hammermeister KE, Kennedy JW, Hamilton GW, et al. Aortocoronary saphenous vein bypass: failure of successful grafting to improve resting left ventricular function in chronic angina N Engl J Med 1974;290:186.[Medline]
- Shepherd RL, Itscoitz SB, Glaney DL, et al. Deterioration of myocardial function following aorto-coronary bypass operation Circulation 1974;49:467.[Abstract/Free Full Text]
- Chatterjee K, Swan HJC, Parmley WW, et al. Influence of direct myocardial revascularization on left ventricular asynergy and function in patients with coronary heart disease with and without previous myocardial infarction Circulation 1973;47:276.[Abstract/Free Full Text]
- Wolf NM, Kreulen TH, Bone AA, et al. Left ventricular function following coronary bypass surgery Circulation 1978;58:63.[Free Full Text]
- Marshall RC, Wisenberg G, Schelbert HR, Henze E. Effect of oral propranolol on rest, exercise and post-exercise left ventricular performance in normal subjects and patients with coronary artery disease Circulation 1981;63:572.[Abstract/Free Full Text]