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Objective To investigate the effects of coronary artery bypass grafting in different bypass grafts on survival rate,angina recurrence rate and cardiac function in patients with diffuse right coronary artery disease.Methods Sixty-four patients with diffuse right coronary artery stenosis admitted to the hospital were enrolled.All patients underwent coronary artery bypass grafting and were divided into large saphenous vein group(40 cases) and internal mammary artery group(24 cases) according to the difference of graft vessels.The follow-up survival rate,bypass graft vascular/cardiac venous patency rate,angina recurrence rate,NYHA classification before and after surgery,left ventricular ejection fraction(LVEF),and left ventricular diastolic end diameter(LVEDD) level of both groups were compared.Results Comparison in the same group,NYHA cardiac function grading,LVEF and LVEDD levels were better than those before surgery(P ＜ 0.05).Compared with the great saphenous vein group,the difference of the venous patency/intracardiac venous patency rate and angina pectoris was better in the internal mammary artery group (P ＜ 0.05).At 1 year after operation,there was no significant difference in NYHA cardiac function grading,LVEF,LVEDD level and follow-up survival rate(P ＞0.05).Conclusion There is no significant difference in follow-up survival rate and long-term improvement of cardiac function between patients with diffuse right coronary artery stenosis undergoing coronary venous artery bypass grafting with saphenous vein and internal mammary artery bypass graft.However,the internal mammary artery is more helpful to improve the patency of the bypass graft vessel/cardiac vein and avoid the recurrence of angina pectoris.
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BACKGROUND: Right ventricular (RV) function has important prognostic implications in off-pump coronary artery bypass surgery (OPCAB). This study investigated the effect of the extent of right coronary artery (RCA) stenosis on RV function and hemodynamics in patients undergoing OPCAB. METHODS: Fifty five patients undergoing OPCAB were divided into two groups according to the degree of RCA stenosis; patients with RCA stenosis of or = 80% (Group 2, n = 29). RV ejection fraction (RVEF) and RV volumetric parameters were measured using thermodilution technique. Hemodynamic variables were recorded 5 min after induction (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (T2), the obtuse marginalis branch (T3) and the RCA (T4) and 5 min after sternum closure (T5). RESULTS: There were no significant differences in hemodynamic variables between two groups during all study periods except in RVEF. RVEF was significantly greater at T2 and T5 in Group 1 than in Group 2. It decreased significantly at T4 in Group 1 and at T3 and T4 in Group 2 compared to values at T1. CONCLUSIONS: RVEF significantly decreased at T2 and T5 in group 2 patients. Other variables affecting the RV function such as cardiac output, pulmonary vascular resistance and RV end diastolic volume index showed no differences between the two groups. These findings suggest that the degree of RCA stenosis has contributed to the decrease in RVEF in patients undergoing OPCAB.