Effect of competitive flow and diltiazem on postoperative hemodynamics and long term patency rate after coronary artery bypass grafting

Abstract

Purpose: To determine the effect of competitive flow and diltiazem on postoperative hemodynamics and long-term patency rate in patients undergoing coronary artery bypass grafting (CABG). Methods: A retrospective analysis was performed on the clinical records of 98 patients who underwent CABG at Qilu Hospital of Shandong University from March 2018 to September 2020. Among them, 47 patients who underwent CABG alone were assigned to control group, while 51 patients who received additional diltiazem were assigned to study group. The severity of coronary artery stenosis (CAS) was evaluated through preoperative coronary angiography, and bridge vessel flow compared between severe stenosis and non-severe stenosis groups. Changes in hemodynamic parameters between two groups were compared before surgery, as well as 12 and 24 h after surgery. Results: A significantly higher bridge vessel blood flow was found in severe stenosis group compared to non-severe stenosis group (p < 0.05). The CAS severity and bridge vessel blood flow revealed an inverse relationship (r = - 0.792, p < 0.001). At 12 and 24 h post-surgery, the study group exhibited significantly lower central venous pressure (CVP), heart rate (HR) and mean arterial pressure (MAP) than the control group (p < 0.05). There was no significant difference in adverse cardiovascular effects (ACEs), between the two groups after 12 months (p > 0.05). Similarly, there was no significant difference in graft patency rate, mild stenosis rate, severe stenosis rate, complete occlusion rate, and linear signs rate 12 months post-operation (p > 0.05). However, the patency rate was significantly higher in cases with severe stenosis (p < 0.05). Conclusion: Postoperative administration of diltiazem in patients undergoing CABG improves systemic hemodynamic parameters. However, competitive blood flow may potentially decrease the long-term patency rate of bridge vessels in patients.