Department of Cardiovascular Surgery, Istanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Istanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
J Cardiothorac Surg. 2024 Oct 29;19(1):615. doi: 10.1186/s13019-024-03043-9.
Graft choices other than left anterior descending artery (LAD)-internal thoracic artery (ITA) anastomosis in coronary artery bypass grafting (CABG) surgery are still controversial. Although 2-dimensional transthoracic echocardiography (2D TTE) is still the most commonly used method, more is needed to diagnose myocardial dysfunction. Ventricular strain values obtained by speckle tracking echocardiography (STE) or tissue Doppler imaging (TDI) methods can much better detect subclinical changes. This study aims to detect early postoperative myocardial function changes compared to single ITA/Bilateral Internal Thoracic Artery (BITA) use by measuring 3-dimensional ejection fraction (3D EF) and ventricular strain values and comparing them according to graft preference.
The study included 35 isolated CABG patients. All patients underwent on-pump CABG via sternotomy. The patients were divided into two groups using single ITA and BITA. Preoperative and postoperative 1st-week 3D EF and ventricular strain values of the patients were calculated using semi-automatic software. The recorded data were compared and evaluated between the two groups.
Of The 35 patients participating in the study, 74.3% (n = 26) were male, 25.7% (n = 9) were female, and their average age was 62.7 ± 7.9 years. Preoperative 3D EF values of the patients were 54.4 ± 8.3% and postoperative 49.5 ± 8.2%. The mean preoperative Apical Long Axis Longitudinal Strain (APLAX LS) was calculated as - 16.2 ± 5.0%, 4 Chambers Longitudinal Strain (4CH LS)-16.8 ± 4.6%, 2 Chambers Longitudinal Strain (2CH LS) - 17.0 ± 4.9%, and Global Longitudinal Ventricular Strain (GLVS) - 16.7 ± 4.2%. Postoperative strain values were measured as - 15.1 ± 4.8%, - 14.7 ± 4.9%, - 14.6 ± 5.6% and - 14.8 ± 4.6%, respectively. When the groups were evaluated within themselves, the mean preoperative 3D EF of the patients in the single ITA group was 52.5 ± 8.8%, while the postoperative mean was 47.7 ± 6.0%. In the BITA group, preoperative 3D EF was 56.3 ± 7.5 and postoperative 51.4 ± 9.8. A decrease in strain values was detected in all groups except APLAX planes.
In our study, no statistically significant difference was observed in terms of myocardial function changes according to the use of ITA/BITA. However, the decline in postoperative strain values of patients in the BITA group was more remarkable, and it was thought that this may be due to prolonged aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times.
在冠状动脉旁路移植术（CABG）中，除左前降支（LAD）-内乳动脉（ITA）吻合术以外的移植物选择仍存在争议。尽管二维经胸超声心动图（2D TTE）仍然是最常用的方法，但仍需要更多的方法来诊断心肌功能障碍。斑点追踪超声心动图（STE）或组织多普勒成像（TDI）方法获得的心室应变值可以更好地检测亚临床变化。本研究旨在通过测量 3 维射血分数（3D EF）和心室应变值来检测与单一 ITA/双侧内乳动脉（BITA）使用相比的术后早期心肌功能变化，并根据移植物选择进行比较。
该研究纳入了 35 例孤立性 CABG 患者。所有患者均通过胸骨切开术进行体外循环下 CABG。根据使用的 ITA 和 BITA 将患者分为两组。使用半自动软件计算患者术前和术后第 1 周的 3D EF 和心室应变值。比较两组之间的记录数据。
35 例参与研究的患者中，74.3%（n=26）为男性，25.7%（n=9）为女性，平均年龄为 62.7±7.9 岁。患者术前 3D EF 值为 54.4±8.3%，术后为 49.5±8.2%。术前平均心尖长轴纵向应变（APLAX LS）为-16.2±5.0%，4 腔室纵向应变（4CH LS）为-16.8±4.6%，2 腔室纵向应变（2CH LS）为-17.0±4.9%，整体纵向心室应变（GLVS）为-16.7±4.2%。术后应变值分别测量为-15.1±4.8%、-14.7±4.9%、-14.6±5.6%和-14.8±4.6%。当在自身组内进行评估时，单一 ITA 组患者的术前平均 3D EF 为 52.5±8.8%，而术后平均为 47.7±6.0%。在 BITA 组中，术前 3D EF 为 56.3±7.5，术后为 51.4±9.8。所有组除 APLAX 平面外，均检测到应变值下降。
在我们的研究中，根据 ITA/BITA 的使用情况，心肌功能变化无统计学意义。然而，BITA 组患者术后应变值下降更为明显，这可能是由于主动脉阻断（CC）和体外循环（CPB）时间延长所致。
