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Gastroepiploic-coronary anastomosis. A viable alternative bypass graft
Insights
The right gastroepiploic artery offers a viable alternative for coronary artery bypass grafting to the heart's posterior surface when internal mammary arteries are unsuitable. Early results show promising feasibility and patient survival, suggesting its potential as a preferred graft. Keywords: gastroepiploic artery, coronary artery bypass, myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Cardiac Revascularization
Background:
- Internal mammary arteries are increasingly used for myocardial revascularization.
- Reaching the posterior cardiac surface with internal mammary grafts can be challenging.
- Alternative arterial conduits are needed for posterior coronary vessel revascularization.
Purpose of the Study:
- To evaluate the feasibility and early outcomes of using the right gastroepiploic artery as a bypass graft.
- To assess its utility for revascularizing posterior coronary arteries when traditional grafts are unsuitable.
Main Methods:
- The right gastroepiploic artery was used as a pedicle graft in nine patients.
- Grafts were directed to the distal right coronary artery, posterior descending artery, and distal circumflex branches.
- Graft patency was assessed using celiac axis opacification and coronary angiography.
Main Results:
- Eight out of nine patients survived the operation.
- Graft patency was confirmed in six patients and strongly suggested in two others.
- All surviving patients were in New York Heart Association Class I or II functional status.
Conclusions:
- The right gastroepiploic artery is a feasible bypass graft for posterior coronary vessels.
- It serves as a valuable alternative when standard conduits like internal mammary arteries are not optimal.
- Further studies on long-term patency are warranted to establish its role as a preferred graft.
Abstract:
Although increasing use is being made of arterial grafts (the internal mammary arteries) for direct myocardial revascularization, it is frequently not possible to reach the posterior surface of the heart with the internal mammary as either a pedicle or a free graft. Since June 1984 we have used the right gastroepiploic artery in nine patients as a pedicle graft to the distal right coronary artery (four patients), the posterior descending artery (three patients), and the distal circumflex branches (two patients). Eight patients survived the operation. Celiac axis opacification confirmed patency in six and coronary angiography strongly suggested patency in the remaining two. All survivors are functionally in New York Heart Association Class I or II. The early angiographic and clinical results demonstrate the feasibility of using the right gastroepiploic artery as a bypass graft to coronary vessels on the posterior surface of the heart when traditional conduits are unsuitable. If its long-term patency as a living arterial graft is similar to that of the internal mammary arteries, the gastroepiploic artery may become the coronary bypass graft of choice for the distal right coronary and circumflex systems.