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Clinical experience with the right gastroepiploic artery in coronary artery bypass grafting
L P Perrault1, M Carrier, Y Hébert
1Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Insights
The right gastroepiploic artery (RGEA) shows high patency rates when used as a coronary artery bypass graft. This study found 90% of RGEA grafts were patent post-surgery, suggesting its potential as an alternative conduit.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease Treatment
Background:
- Internal mammary artery grafts demonstrate excellent long-term results in coronary artery bypass grafting.
- The search for alternative conduits with similar characteristics is ongoing.
- The right gastroepiploic artery (RGEA) is being investigated as a potential graft material.
Purpose of the Study:
- To evaluate the efficacy and safety of using the right gastroepiploic artery (RGEA) as an in situ graft for coronary artery bypass grafting (CABG).
- To assess the patency rates of RGEA grafts in patients with coronary artery disease.
Main Methods:
- Prospective study involving 51 patients undergoing CABG between December 1989 and December 1991.
- RGEA used as an in situ graft to the posterior descending coronary artery.
- Angiographic evaluation of graft patency performed before discharge and at 1-year follow-up.
Main Results:
- No operative mortality observed in the study cohort.
- 90% (28/31) of RGEA grafts were patent at initial angiographic evaluation.
- At 1-year follow-up, 4 out of 5 RGEA grafts remained patent.
Conclusions:
- The right gastroepiploic artery (RGEA) is a safe and effective conduit for coronary artery bypass grafting.
- RGEA demonstrates high patency rates, comparable to other arterial grafts.
- RGEA represents a promising alternative for patients requiring coronary revascularization.
Abstract:
The excellent long-term results with the internal mammary artery for coronary artery bypass grafting have prompted the search for other conduits with similar characteristics. From December 1989 to December 1991, the right gastroepiploic artery (RGEA) has been used as an in situ graft to the posterior descending coronary artery in 51 patients at the Montreal Heart Institute. The patients' age averaged 50 +/- 11 years. Three-vessel coronary artery disease was present in 41 patients and two-vessel disease in the remaining 10 patients. In all but 1 patient, bilateral internal mammary artery grafting was performed in addition to RGEA grafting. The number of grafts per patient averaged 3.2 +/- 0.8. There was no operative mortality. Morbidity was minimal with only myocardial infarction and a pleural effusion in 1 patient. In 1 patient, a splenectomy had to be performed because of iatrogenic tear during dissection of the RGEA. The average hospital stay was 8.2 +/- 2.6 days. Enteral nutrition was resumed on average 2 days after operation. Angiographic evaluation of RGEA grafts was performed before discharge or within the first month after surgery in 31 patients. In 28 patients (28/31, 90%) the RGEA graft was patent, two grafts were occluded, and in the remaining patient, the graft could not be visualized due to technical difficulties during angiography. A second angiographic evaluation was performed in 5 patients, 1 year after operation. Four RGEAs were patent and 1 was occluded. Clinical follow-up averaged 4 months (range 1 to 15 months).(ABSTRACT TRUNCATED AT 250 WORDS)