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Technical aspects and late functional results of gastroepiploic bypass grafting (400 cases)
O Jegaden1, A Eker, P Montagna
1Department of Cardiovascular Surgery, Hôpital cardiologique Louis Pradel, BP Lyon-Monchat, France.
Insights
Right gastroepiploic artery (GEA) bypass surgery offers safe and effective myocardial revascularization. This study shows high patency rates, excellent symptom relief, and good midterm survival for GEA grafts in coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- The right gastroepiploic artery (GEA) is increasingly utilized for myocardial revascularization.
- Coronary artery bypass grafting (CABG) remains a cornerstone treatment for coronary artery disease.
- Assessing the efficacy and safety of arterial grafts like the GEA is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To evaluate the outcomes of myocardial revascularization using the right gastroepiploic artery (GEA) in patients undergoing isolated coronary surgery.
- To assess the early and midterm patency, functional results, and survival rates of GEA grafts.
- To determine the safety profile and complication rates associated with GEA utilization in CABG.
Main Methods:
- Retrospective analysis of 400 patients who underwent myocardial revascularization with GEA from January 1990 to February 1994.
- GEA was used alone, with one internal mammary artery (IMA), or with bilateral IMAs, aiming for complete arterial revascularization.
- Early postoperative angiography, exercise stress tests, and 2- and 4-year actuarial survival rates were assessed.
Main Results:
- Complete myocardial revascularization was achieved in 79% of patients.
- Early mortality was 1.7%, influenced by left ventricular ejection fraction.
- Early GEA graft patency was 92%, with 99% of patients symptom-free at 3 months post-surgery. Two- and 4-year survival rates were 96.7%.
- Late cardiac events occurred at 2% patient/year, with 98% of patients symptom-free at 2-year follow-up without medication.
Conclusions:
- Myocardial revascularization with the right gastroepiploic artery is associated with minimal operative risk.
- GEA grafting provides satisfactory functional results and midterm survival rates in patients undergoing coronary artery bypass grafting.
- Complete arterial revascularization using GEA and internal mammary arteries is feasible and effective.
Abstract:
From January 1990 to February 1994, 400 patients (mean age 59 +/- 9 years) underwent myocardial revascularization using the right gastroepiploic artery (GEA) to bypass the right coronary artery trunk or branches. They represented 40% of all patients undergoing isolated coronary surgery during the same period, from 19% in 1990 to 54% in 1994. Left ventricular function was normal in 32% of patients, moderately impaired in 62% and severely impaired in 6%. The GEA was used alone in six patients, associated with one internal mammary artery (IMA) in 111 patients (two arterial grafts, 2.2 +/- 0.4 anastomoses) and with both IMAs in 283 patients (three arterial grafts, 3.4 +/- 0.6 anastomoses); no vein graft was used. The rate of complete myocardial revascularization was 79%. Early mortality was 1.7% and influenced by left ventricular ejection fraction (P < 0.05). Complications occurred in 37 patients: myocardial infarction 4%, intra-aortic balloon pump 0.5%, reoperation for bleeding 0.5%, mediastinitis 0.25%. Early (15th postoperative day) angiographic control of the GEA graft was performed in 104 patients operated from January 1990 to December 1991 and the patency rate was 92%; anomalies of GEA were three occlusions, five stenoses, three competitive flow, no string or slender sign. Early functional results (3 +/- 1 months postoperatively) were studied in 192 patients during exercise test with medical treatment: 99% were symptom-free and 14% had electrocardiographic (ECG) ischemic modification significantly correlated with incomplete revascularization (P < 0.01). The 2- and 4-year actuarial survival rate was 96.7 +/- 1.9%. The rate of late cardiac events was 2% patient/year; Angioplasty for GEA graft failure was required in four patients. A 2-year postoperative functional assessment without medical treatment was performed during exercise test in 66 patients who had received three arterial grafts: 98% were symptom-free and 26% had ECG ischemic modification significantly correlated with incomplete revascularization (P < 0.01); during the same procedure, thallium myocardial scintigraphy was obtained in 50 patients: 18 patients (36%) had asymptomatic ischemic defects on exercise significantly correlated with incomplete revascularization and ECG ischemic changes (P < 0.01). However, posterior thallium defects demonstrated limited GEA flow at the maximum level of exercise in at least 8% of patients. Myocardial revascularization using the GEA can be achieved with minimal operative risk and offers satisfactory functional results and midterm survival rate.