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Coronary artery bypass grafting with both internal thoracic arteries and the right gastroepiploic artery
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Coronary artery bypass grafting using both internal thoracic arteries and the right gastroepiploic artery demonstrated excellent long-term results. This surgical approach offers a high graft patency rate and low operative risk for patients with complex coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease.
- The use of arterial grafts, including internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA), is preferred for long-term patency.
- Combining multiple arterial grafts may improve outcomes in complex cases.
Purpose of the Study:
- To evaluate the clinical outcomes of coronary artery bypass grafting (CABG) using both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA).
- To assess graft patency rates and long-term survival after this composite arterial grafting strategy.
Main Methods:
- A retrospective review of 83 patients who underwent CABG with both ITAs and RGEA between July 1989 and March 1995.
- Detailed analysis of graft types, number of anastomoses, and postoperative complications.
- Graft patency assessed by angiography 3-4 weeks postoperatively; long-term follow-up included survival and cardiac event rates.
Main Results:
- No operative or hospital deaths; no perioperative myocardial infarctions.
- High arterial graft patency: 96% overall, with 95% for left ITA, 100% for right ITA, and 93% for RGEA.
- 5-year actuarial survival rate of 90.1% and cardiac event-free rate of 86.6%.
Conclusions:
- Coronary artery bypass grafting with both ITAs and RGEA is a safe and effective procedure.
- This strategy yields satisfactory clinical outcomes with low operative risk, high graft patency, and excellent long-term results.
- The combined use of bilateral ITAs and RGEA is a viable option for complex coronary artery disease requiring extensive arterial revascularization.
Abstract:
From July 1989 to March 1995, 83 patients (79 men, 4 women, mean age 58.3 years, range 35 to 76 years) underwent coronary artery bypass grafting with the both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). Postoperative follow-up ranged from one to 69 months with a mean of 31 months. Seventy-eight patients (94%) had either triple vessel disease or left main disease. A total of 264 distal anastomoses with arterial grafts were constructed; 90 with the left ITA, 73 with the right ITA, 90 with the RGEA and 1 with the inferior epigastric artery (IEA). An additional saphenous vein graft was constructed in 13 patients including 4 sequential bypass grafting. The mean number of distal anastomoses was 3.4. Postoperative angiography was performed in 80 patients (96%) 3 to 4 weeks after the operation. There were no operative deaths or hospital deaths. No patients developed perioperative myocardial infarction. Graft patency in arterial grafts was 96% (242/253), 95% (80/84) in the left ITA, 100% (82/82) in the right ITA and IEA (1/1), and 93% (80/86) in the RGEA. Graft patency in vein grafts was 99% (84/85) and overall patency rate was 96% (326/338). Four patients (5%) died during follow-up period but all were non-cardiac deaths. Six postoperative percutaneous transluminal coronary angioplasties (PTCA) (7%) and two reoperations (re-CABG) (2%) were required, but no patients developed myocardial infarction (MI). The 5-year actuarial survival rate and cardiac event (cardiac death, MI, PTCA, and re-CABG) free rate was 90.1% and 86.6% respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with the both ITAs and RGEA was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.