Bypass to the distal right coronary artery using in situ gastroepiploic artery
Hitoshi Hirose1, Atsushi Amano, Akihito Takahashi
1Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan. genex@nifty.com
Insights
Coronary artery bypass grafting using the gastroepiploic artery (GEA) for the right coronary artery (RCA) demonstrated satisfactory outcomes. GEA graft patency was comparable to other graft materials, showing its viability for bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Cardiac Surgery Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Graft selection is crucial for long-term patency and patient outcomes.
- The gastroepiploic artery (GEA) is an alternative conduit for arterial revascularization.
Purpose of the Study:
- To evaluate the clinical outcomes of CABG using the in situ GEA exclusively for distal right coronary artery (RCA) bypass.
- To assess the long-term patency rates of GEA grafts to the distal RCA.
- To compare GEA graft performance with other commonly used arterial and venous grafts.
Main Methods:
- Retrospective analysis of 1020 patients undergoing CABG with in situ GEA to the distal RCA between 1991 and 2002.
- Perioperative and long-term follow-up data, including clinical events and angiography, were analyzed.
- GEA patency rates were compared with saphenous vein, radial artery, and right internal thoracic artery grafts.
Main Results:
- In-hospital morbidity was 15.1% and mortality was 0.6%.
- Actuarial 5-year freedom from angina or reintervention was 89.9%, and survival was 91.6%.
- GEA patency rates at 1, 3, and 5 years were 95.7%, 90.2%, and 85.7%, respectively, with no significant difference compared to other grafts (p=0.29).
Conclusions:
- GEA grafting to the distal RCA provides satisfactory perioperative and long-term clinical results.
- The angiographic patency of GEA grafts to the distal RCA is not inferior to that of saphenous vein grafts.
- GEA is a viable option for arterial revascularization in CABG surgery.
Objective:
We investigated the clinical outcomes after coronary artery bypass grafting (CABG) using the in situ gastroepiploic artery (GEA) exclusively bypassing to the distal right coronary artery (RCA).
Methods:
Between, 1991 and 2002, 1020 consecutive patients (788 male and 232 female with a mean age of 63.6 +/- 9.7) underwent CABG to the distal coronary artery using in situ GEA in the Shin-Tokyo Hospital Group. Their perioperative and follow-up data were retrospectively analyzed.
Results:
The in-hospital morbidity rate was 15.1% and the mortality rate was 0.6%. Postoperative myocardial infarction associated with GEA graft failure occurred in two cases. Among the survivors, follow-up was completed in all patients with a mean period of 4.7 +/- 2.4 years. Actuarial 3- and 5-year angina or intervention-free rates were 93.6% and 89.9%, respectively. Actuarial 3- and 5-year survival rates were 95.8% and 91.6%, respectively. Postoperative angiography was performed on 482 patients within 1 year, 115 patients with 3 years, and in 87 patients more than 4 year after surgery. The GEA patency rates at 1, 3, and 5-year were 95.7%, 90.2%, and 85.7%, respectively. These patency rates were compared with other graft materials (the saphenous vein n = 291, radial artery n = 186, and right internal thoracic artery n = 23) used for bypass to the distal RCA, and we found no significant differences (p = 0.29).
Conclusion:
The perioperative and clinical remote results of GEA grafting were satisfactory. The angiographic patency rates of GEA to the distal RCA was not inferior to the saphenous vein graft in this study.
