Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries

Area of Science:

• Cardiovascular Surgery
• Gastrointestinal Surgery
• Surgical Oncology

Background:

• The right gastroepiploic artery (GEA) is a preferred arterial graft for coronary artery bypass grafting (CABG).
• Concerns exist regarding the management of patent in situ GEA during subsequent abdominal surgeries.
• This study addresses the safety and management of GEA grafts in patients undergoing abdominal procedures post-CABG.

Purpose of the Study:

• To evaluate the outcomes of abdominal surgeries in patients with a patent in situ GEA used for CABG.
• To determine the safety and feasibility of managing GEA grafts during abdominal interventions.
• To establish guidelines for intraabdominal GEA management in specific surgical contexts.

Main Methods:

• Retrospective analysis of 278 patients who underwent CABG using GEA from 1995 to 2016.
• Identification of 11 patients (14 surgeries) who subsequently required abdominal surgery with a patent GEA.
• Review of surgical procedures, graft management, and patient outcomes.

Main Results:

• No GEA graft injury occurred during abdominal surgery.
• Planned abdominal procedures were completed without circulatory compromise.
• Intraabdominal off-pump rerouting of GEA was required in 3 pancreaticoduodenectomy cases.
• No operative mortality or graft-related cardiac events were observed, except for one case of multiple organ failure.

Conclusions:

• Abdominal surgery can be safely performed in patients with a patent in situ GEA coronary graft.
• Intraabdominal GEA rerouting is a feasible and necessary technique for specific complex abdominal surgeries like pancreaticoduodenectomy.
• The findings support the continued use of GEA for CABG, with established protocols for managing abdominal interventions.