Complete arterial myocardial revascularization using the right gastroepiploic artery and both internal thoracic
G Tavilla1, E Berreklouw, J Schönberger
1Department of Cardio-Thoracic Surgery Catharina Hospital, Eindhoven, The Netherlands.
Insights
Complete arterial myocardial revascularization using the right gastroepiploic artery and both internal thoracic arteries as pedicled grafts is feasible. This approach yielded excellent mid-term results in selected patients with three-vessel disease.
Area of Science:
- Cardiovascular Surgery
- Surgical Innovation
- Arterial Grafting
Background:
- Coronary artery bypass grafting (CABG) traditionally uses vein grafts.
- Complete arterial revascularization aims to improve long-term graft patency.
- Minimizing or eliminating vein graft use is a surgical goal.
Purpose of the Study:
- To evaluate the efficacy of using the right gastroepiploic artery (RGEA) and bilateral internal thoracic arteries (BITA) for complete arterial myocardial revascularization.
- To assess the mid-term outcomes of this all-arterial grafting strategy without vein grafts.
Main Methods:
- A prospective study involving 105 patients with three-vessel disease from March 1989 to July 1994.
- Utilized pedicled RGEA and BITA grafts for distal anastomoses.
- Total of 363 distal anastomoses constructed (108 RGEA, 255 BITA), averaging 3.4 per patient.
Main Results:
- No hospital mortality observed.
- Seven patients (6.7%) required re-thoracotomy for ischemia or bleeding.
- Follow-up averaged 21 months, with 95% of patients in NYHA class I or II and no late complications.
Conclusions:
- Complete myocardial revascularization using RGEA and BITA as pedicled grafts is achievable in selected patients.
- This all-arterial grafting strategy demonstrates excellent mid-term results.
- Eliminating vein grafts in CABG can be a safe and effective option.
Abstract:
To achieve complete arterial myocardial revascularization without vein grafts, the right gastroepiploic artery and both internal thoracic arteries were used as pedicled grafts in 105 patients from March 1989 to July 1994. There were 101 male and 4 female patients, with a mean age of 51 years (range 32 to 65 years). Three-vessels disease was present in all patients. Six patients underwent previous bypass procedures with the use of vein grafts. A total of 363 distal anastomosis (108 with the right gastroepiploic artery, 255 with both internal thoracic arteries) were constructed. The mean number of distal anastomoses was 3.4. There was no hospital mortality. Seven patients required a rethoracotomy: 5 because of post-operative signs of ischemia, 2 because of bleeding. In one patient a splenectomy had to be performed because of bleeding. A new Q wave was noted in 2 patients. Follow-up averaged 21 months (range 1 to 67 months). Ninety nine (95%) of the patients were in NYHA class I, 6 (5%) in class II. No late complications were noted. We conclude that, complete myocardial revascularization using the right gastroepiploic artery in combination with both internal thoracic arteries as pedicled grafts can be achieved in selected patients with excellent mid term results.
