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Initial experience with MIDCAB grafting using the gastroepiploic artery
J D Fonger1, J R Doty, J D Salazar
1Division of Cardiac Surgery, Sinai Hospital of Baltimore, Maryland, USA. jfonger@heartnet.org
The Annals of Thoracic Surgery
|September 4, 1999
Summary
Minimally invasive direct coronary artery bypass grafting using the gastroepiploic artery showed an 88% symptom resolution rate. However, lower-than-expected patency rates and significant morbidity/mortality were observed in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) with the gastroepiploic artery is an option for revascularizing specific heart surfaces.
- This technique is applicable in both primary operations and reoperations.
Purpose of the Study:
- To evaluate the efficacy and outcomes of gastroepiploic artery MIDCAB.
- To assess graft patency, morbidity, and mortality in patients undergoing this procedure.
Main Methods:
- Seventy-four patients with single-coronary-distribution symptomatic coronary artery disease underwent MIDCAB using the gastroepiploic artery.
- Grafting targeted the distal right coronary artery, posterior descending artery, or distal left anterior descending coronary artery.
- Patients were followed with clinical visits, Doppler, and selective recatheterization.
Main Results:
- The study included 33 primary operations and 41 reoperations.
- Six perioperative deaths (8%) occurred.
- Recatheterization in 28% revealed graft and anastomotic stenoses.
- At a mean follow-up of 10.9 months, 88% of patients experienced symptom resolution.
Conclusions:
- Gastroepiploic artery MIDCAB can avoid sternotomy and cardiopulmonary bypass risks.
- Observed patency rates were lower than anticipated.
- High-risk patients faced significant morbidity and mortality, necessitating long-term follow-up for graft patency and survival assessment.