The influence of coronary collateral circulation on perioperative cardiac function in aorto-coronary bypass grafting
Harada, Y.
Nihon Kyobu Geka Gakkai 36(8): 1352-1361
1988
ISSN/ISBN: 0369-4739 PMID: 3264001 Document Number: 317159
Coronary artery bypass grafting has been widely accepted as an established surgical treatment for ischemic heart disease. But the effect and the role of coronary collateral circulation remain until unknown in details on the cardiac function before and after aorto-coronary bypass grafting (ACBG). The influence of coronary collateral circulation on the perioperative cardiac function in the patient with ACBG was clinically evaluated. All cases were divided into two groups according to the angiographic findings whether collateral circulation was observed preoperatively (collateral group) or not (non-collateral group). In the early postoperative period, the effect of collateral circulation was evaluated in 45 cases those required the circulatory assistance of the intra-aortic balloon pumping (IABP) postoperatively. In these cases, collateral circulation was observed in 21 cases preoperatively (collateral group), and was not in the remaining 24 cases (non-collateral group). In the collateral group, the assist interval of IABP was shorter and improvement of cardiac function was significantly betterat 12 to 24 hrs. after IABP insertion compared to those of non-collateral group. In the late postoperative evaluation, one hunded and fifty four patients were divided into two groups: an angina group, which had no history of previous myocardial infarction, and a myocardial infarction group, which had a history of previous myocardial infarction. The angina group of 64 cases consisted of 24 cases with collateral circulation and 40 cases without collateral circulation, and the myocardial infarction group of 90 cases consisted of 52 cases with collateral circulation and 38 cases without collateral circulation. In the angina group, the improvement of cardiac index (CI) was observed postoperatively on the cases with or without collaterals, and left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF) remained unchanged in cases with or without collaterals after ACBG. In the myocardial infarction group, all parameters of the left ventricular function, including CI, LVEDP, and LVEF revealed significant improvement in cases with collateral circulation, and the effect of coronary artery bypass grafting was noted much more markedly than those of the angina group. Concerning with the change of the left ventricular segmental motion before and after ACBG, in the angina group, a significant improvement was noted only in the anterior wall motion in the cases with or without collaterals, however, in the mycoardial infarction group, the significant improvement was noted in the both anterior and apical wall motion after ACBG in the cases with collateral circulation. These results suggested that the influence of coronary collateral circulation in ACBG was more evident in the myocardial infarction group than in the angina group, and that in the myocardial infarction group, coronary collateral circulation may contribute to maintain myocardial viability in the infarcted and peri-infarcted area. In conclusion, coronary collateral plays an effective role in the both early and late postoperative periods for the improvement of the cardiac function after aorto-coronary bypass grafting.