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Ergin Eren
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J Thorac Cardiovasc Surg 2004;127:1133-1138
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Revascularization of multiple bypassable extended right coronary arteries

Mehmet Rasit Güney, MDa,*, Ergin Eren, MDa

a Siyami Ersek Chest and Cardiovascular Surgery Center, Istanbul, Turkey

Received for publication April 17, 2003; revisions received May 12, 2003; revisions received July 3, 2003; accepted for publication July 14, 2003.

* Requests for reprints: Mehmet Rait Güney, Derya sok, Beta-2 site E-blok No. 2/53 Sahrayi Cedid, 81060, Istanbul, Turkey
mrguney{at}e-kolay.net

BACKGROUND: Extended right coronary arteries are not uncommon in coronary surgery. They can be revascularized optionally either by conventional single or complete multiple bypassing. However, there are still no objective data showing the superiority or appropriateness of one of these methods over the other.

METHODS: Extended right coronary arteries were identified by preoperative angiographic scoring and randomized to multiple-bypassing (group A; n = 32) or single-bypassing (group B; n = 32) groups. Four parameters that show the completeness of right coronary territory revascularization were evaluated and compared between the 2 groups.

RESULTS: Although overall perioperative ischemic events seemed to increase in the single-bypass group (P = .0059), half of them were reversible, and there were no statistical differences between the definitive perioperative ischemic event rates, namely, infarction rates, and the remaining 3 parameters of the groups. Logistic regression analysis showed that preoperative left ventricular dysfunction (ejection fraction <50%) was the most significant predictor of these perioperative ischemic events. Hence, the subgroups of patients with left ventricular dysfunction were also evaluated (subgroup A, n =13; subgroup B, n = 12). Overall perioperative ischemic event (P = .001), definitive perioperative ischemic event (infarction; P = .0324), and consequent right ventricular dysfunction (P = .0324) rates were significantly higher in the single-bypass subgroup. Postoperative reperfusion status and graft patency rates of the right coronary territory did not change with the different revascularization methods.

CONCLUSIONS: Complete revascularization of extended right coronary arteries did not seem advantageous over its conventional operation in patients with normal ventricular function; however, in patients with poor ventricular function (ejection fraction <50%), it prevented perioperative ischemic events in the right coronary territory and the consequent functional impairment that appeared with conventional operation.






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