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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
Insights
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.
Background:
Minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery can be used in primary operations and reoperations to revascularize the inferior or anterior surface of the heart.
Methods:
Patients who had symptomatic coronary artery disease limited to a single coronary distribution were selected. Coronary targets were grafted with the pedicled gastroepiploic artery through a small midline epigastric incision. Patients were followed with scheduled outpatient clinic visits, Doppler examination, and selective recatheterization.
Results:
Between May 1995 and November 1997, 74 patients underwent gastroepiploic artery minimally invasive direct coronary artery bypass grafting; 33 (45%) had a primary operation and 41 (55%), a reoperation. Grafting was performed to the distal right coronary artery (n = 38), the posterior descending artery (n = 28), or the distal left anterior descending coronary artery (n = 8). There were six deaths (8%) within 30 days after operation. Twenty patients (28%) underwent recatheterization; there were two graft occlusions, two graft stenoses, and five anastomotic stenoses. Of 60 patients seen 2 or more weeks after operation, 53 (88%) had resolution of anginal symptoms at a mean follow-up of 10.9 months (range, 0 to 30 months).
Conclusions:
Inferior minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery avoids the risks of repeat sternotomy, aortic manipulation, and cardiopulmonary bypass. Patency rates, however, were lower than expected, and there is significant morbidity and mortality associated with high-risk patients undergoing the procedure. Continued follow-up is essential to evaluate long-term graft patency and patient survival.