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Right gastroepiploic-to-coronary artery bypass. The first decade of use
Insights
The right gastroepiploic artery is a suitable option for coronary artery bypass grafting (CABG), offering improved patient outcomes and potential for complete myocardial revascularization. This arterial graft demonstrates good patency rates in short- and long-term follow-ups.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Myocardial Revascularization
Background:
- The right gastroepiploic artery (RGEA) was introduced as a coronary artery bypass graft (CABG) in 1984.
- It has since become an accepted alternative conduit for myocardial revascularization.
Purpose of the Study:
- To evaluate the short-term, intermediate, and long-term results of using the RGEA as a CABG.
- To assess the suitability and efficacy of the RGEA in myocardial revascularization.
Main Methods:
- The RGEA was utilized as a pedicle or free graft in 126 patients undergoing CABG.
- Grafts were directed to various coronary arteries, including the right main, posterior descending, circumflex, and left anterior descending arteries.
Main Results:
- The study included 126 patients (111 male, aged 32-78 years).
- Hospital mortality was 1.6% (2 deaths). Mean postoperative stay was 7.5 days.
- All survivors showed symptomatic improvement (NYHA class I or II).
- Late mortality was 2.4% (3 deaths) over a mean follow-up of 41.4 months.
- Angiography in 44 patients showed RGEA graft patency in 34 (77%) and indirect evidence in 6 (14%).
Conclusions:
- The RGEA is a suitable arterial conduit for CABG.
- Its use, particularly for posterior wall coronary arteries combined with internal mammary arteries, facilitates complete myocardial revascularization.
- The RGEA provides viable arterial grafts with favorable short- and long-term patency.
Background:
The right gastroepiploic artery was first used by us as a coronary artery bypass graft (CABG) in June 1984 and has become an accepted alternative conduit for myocardial revascularization.
Methods And Results:
We have now performed this operation in 126 patients (111 of whom were men) aged 32 to 78 years. The right gastroepiploic artery was used as a pedicle graft to the right main coronary artery in 25 patients, to its posterior descending branch in 90, to a left ventricular branch in 2, to branches of the circumflex system in 6, and to the left anterior descending artery in 1. Free (aortocoronary) gastroepiploic grafts were placed to circumflex branches in 2 patients. There were 2 hospital deaths (stroke, arrhythmia), and mean +/- SD postoperative stay was 7.5 +/- 2.0 days. All survivors were symptomatically improved and are functionally in New York Heart Association functional class I or II. There have been 3 late deaths (at 34, 50, and 84 months) in 2 to 120 months of follow-up (mean, 41.4 months). Angiography of bypass grafts and coronary arteries was performed in 44 patients at 7 days to 80 months postoperatively, providing direct evidence of gastroepiploic graft patency in 34 patients and strong indirect evidence in another 6; adequate data could not be obtained in 3 patients for technical reasons, and 1 graft was occluded.
Conclusions:
These short-term, intermediate, and long-term results demonstrate the suitability of the right gastroepiploic artery as a CABG. The use of the right gastroepiploic artery as a graft to coronary arteries on the posterior wall of the heart, in conjunction with one or both internal mammary arteries, has the potential to allow complete myocardial revascularization with viable arterial grafts.
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