Characteristics of left ventricular and cardiac hemodynamic remodeling after on-pump or off-pump coronary artery bypass grafting

Aim. To study the comparative dynamics of left ventricular (LV) remodeling after on-pump and off-pump coronary artery bypass grafting.

Materials and methods. The study included 129 patients with verified coronary artery disease (CAD) who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump CABF) or beating heart surgery (off-pump CABG). All patients underwent transthoracic echocardiography (TTE) and volumetric compression oscillometry (VCO) before surgery, as well as one week and four months after it. The results were compared in groups divided according to the surgical technique and the presence of previous myocardial infarction using variation series, the Tukey’s post-hoc test, the Pearson correlation coefficient, and the Spearman’s rank correlation coefficient.

Results. According to TTE data, no difference in hemodynamic parameters between the groups in the postoperative period was noted. According to VCO data, a significant difference was revealed in the off-pump group without previous MI one week after surgery: an increase in cardiac output (CO) (p < 0.001), an increase in stroke volume (SV) and stroke index (SI) (p = 0.005), LV power (LVP) (p = 0.015), and also a rise in cardiac index and LVP four months after the surgery. In the on-pump group of patients with previous MI a week after CABG, a decrease in the LVP (p < 0.001) and dynamic changes of energy expenditure (p < 0.001) were observed. The correlation analysis revealed moderate correlations between the inotropic parameters of cardiac hemodynamics SV, SI, CO, LVP and blood pressure (BP) (rπ = 0.33–0.47; p < 0.001) and strong correlations between SV, SI, CO, LVP and ejection fraction (EF) (rπ = 0.63–0.68; p < 0.001).

Conclusion. Seven days after the off-pump CABG, an improvement in some hemodynamic parameters and all inotropic parameters of the heart was revealed compared with the on-pump group. Four months after the off-pump surgery, positive hemodynamic remodeling was observed compared with the postoperative period after the onpump CABG.

1. Поляков Р.С., Абугов С.А., Жбанов И.В., Саакян Ю.М., Пурецкий М.В., Пиркова А.А. и др. Коронарное стентирование у больных ишемической болезнью сердца с многососудистым поражением коронарного русла и низкими оценками по шкале SYNTAX SCORE. Кардиология. 2013;53(10):4–9.

2. Locker C. Off-pump or on-pump coronary artery bypass grafting in diabetes: Is this the important question?. J. Thorac. Cardiovasc. Surg. 2019;157(3):970–971. DOI: 10.1016/j.jtcvs.2018.08.069.

3. Zhang X., Wu Z., Peng X. et al. Prognosis of Diabetic Patients Undergoing Coronary Artery Bypass Surgery Compared With Nondiabetics: A Systematic Review and Meta-analysis. J. Cardiothorac. Vasc. Anesth. 2011;25(2):288–298. DOI: 10.1053/j.jvca.2010.09.021.

4. Mohr F., Morice M., Kappetein A. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The Lancet. 2013;381(9867):629–638. DOI: 10.1016/s0140-6736(13)60141-5.

5. Panza J., Velazquez E., She L. et al. Extent of Coronary and Myocardial Disease and Benefit From Surgical Revascularization in LV Dysfunction. J. Am. Coll. Cardiol. 2014;64(6):553– 561. DOI: 10.1016/j.jacc.2014.04.064.

6. Simard T., Hibbert B., Pourdjabbar A. et al. Percutaneous coronary intervention with or without on-site coronary artery bypass surgery: A systematic review and meta-analysis. Int. J. Cardiol. 2013;167(1):197–204. DOI: 10.1016/j.ijcard.2011.12.035.

7. Ma G., Fan Y., Shao W., Qi L. Meta-Analysis for the Prognosis of On-Pump Versus Off-Pump Coronary Artery Bypass Grafting. J. Am. Coll. Cardiol. 2018;72(3):344–345. DOI: 10.1016/j.jacc.2018.03.544.

8. Takagi H., Ando T., Mitta S. Meta-Analysis Comparing ≥10- Year Mortality of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting. Am. J. Cardiol. 2017;120(11):1933–1938. DOI: 10.1016/j.amjcard.2017.08.007.

9. Kim K., Choi J., Oh S. et al. Twenty-year experience with offpump coronary artery bypass grafting and early postoperative angiography. Ann. Thorac. Surg. 2020;109(4):1112–1119. DOI: 10.1016/j.athoracsur.2019.07.053.

10. Smart N., Dieberg G., King N. Long-term outcomes of on-versus off-pump coronary artery bypass grafting. J. Am. Coll. Cardiol. 2018;71(9):983–991. DOI: 10.1016/j.jacc.2017.12.049.

11. Шидловская С.А., Дедебаева Л.Б., Дегтярев В.А., Чомахидзе П.Ш., Копылов Ф.Ю. Опыт применения объемной компрессионной осциллометрии у пациентов с артериальной гипертензией. Кардиология и сердечно-сосудистая хирургия. 2015;8(2):33–37. DOI: 10.17116/kardio20158233-37.

12. Shi Y., Denault A., Couture P., Butnaru A., Carrier M., Tardif J. Biventricular diastolic filling patterns after coronary artery bypass graft surgery. J. Thorac. Cardiovasc. Surg. 2006;131(5):1080–1086.e3. DOI: 10.1016/j.jtcvs.2006.01.015.

13. Mathison M., Edgerton J., Horswell J., Akin J., Mack M. Analysis of hemodynamic changes during beating heart surgical procedures. Ann. Thorac. Surg. 2000;70(4):1355–1360. DOI: 10.1016/s0003-4975(00)01590-3.

14. Liu J., Tanaka N., Murata K. et al. Prognostic value of pseudonormal and restrictive filling patterns on left ventricular remodelingand cardiac events after coronary artery bypass grafting. Am. J. Cardiol. 2003;91(5):550–554. DOI: 10.1016/s0002-9149(02)03304-0.

15. Martinez E. No Major Differences in 30-Day Outcomes in High-Risk Patients Randomized to Off-Pump Versus On-Pump Coronary Bypass Surgery: The Best Bypass Surgery Trial. Yearbook of Critical Care Medicine. 2010;121(4):498– 504. DOI: 10.1161/CIRCULATIONAHA.109.880443.

16. Ng K., Popovic Z., Troughton R., Navia J., Thomas J., Garcia M. Comparison of left ventricular diastolic function after on-pump versus off-pump coronary artery bypass grafting. Am. J. Cardiol. 2005;95(5):647–650. DOI: 10.1016/j.amjcard.2004.10.043.

17. Zhao D., Edelman J., Seco M., Bannon P., Vallely M. Longterm outcomes following off-pump coronary artery bypass grafting. J. Am. Coll. Cardiol. 2018;72(3):345–347. DOI: 10.1016/j.jacc.2018.04.068.