Transplantation of the en bloc vascular system for coronary revascularization
A Matsuura1, K Yasuura, K Yoshida
1Division of Cardiovascular Surgery, Cardiovascular Center, Aichi Prefectural Owari Hospital, Ichinomiya, Japan.
Insights
A new technique for free gastroepiploic artery grafting, incorporating venous drainage, effectively prevents graft spasm. This method significantly improves the patency rate for coronary artery bypass grafting procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Innovation
Background:
- Free gastroepiploic artery grafts are underutilized for coronary revascularization due to vasospasm.
- Vasospasm in these grafts is hypothesized to result from interrupted venous drainage.
- A novel grafting method was developed to address this limitation.
Purpose of the Study:
- To introduce and evaluate a new technique for free gastroepiploic artery grafting.
- To determine if the new technique prevents graft spasm and improves patency.
- To assess the safety and efficacy of the modified grafting procedure.
Main Methods:
- The study involved 33 patients undergoing coronary artery bypass grafting using the new free gastroepiploic artery technique.
- Grafts were harvested en bloc with satellite veins, ensuring intact venous drainage.
- The gastroepiploic vein was anastomosed to the right atrial appendage for simultaneous venous drainage.
Main Results:
- All 33 free gastroepiploic artery grafts demonstrated patency without spasm on early and late angiography.
- No operative or hospital deaths occurred in the study cohort.
- Flow competition was observed in only 2 of the 33 grafts.
Conclusions:
- The developed free gastroepiploic artery grafting technique with venous drainage effectively prevents spasm.
- This innovative approach leads to a significantly improved graft patency rate.
- The method offers a promising solution for enhancing coronary revascularization outcomes.
Objectives:
Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting.
Methods:
From January 1997 to October 1999, 33 patients underwent coronary artery bypass grafting with the free gastroepiploic artery according to our new method. The gastroepiploic artery graft was harvested en bloc with its satellite veins. The gastroepiploic vein was anastomosed to the right atrial appendage for venous drainage simultaneously with the gastroepiploic artery being grafted in the aortocoronary position.
Results:
A total of 96 distal anastomoses were performed, including 33 free gastroepiploic artery grafts according to our method, 33 in situ left internal thoracic artery grafts, 26 saphenous vein grafts, and 4 radial artery grafts. Neither operative nor hospital death occurred. Early postoperative angiography revealed that all of the 33 free gastroepiploic artery grafts performed with our method were patent without spasm, and flow competition occurred only in 2 of those grafts. On late angiography, all 15 free gastroepiploic artery grafts were patent without spasm.
Conclusions:
The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate.
