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Intermediate clinical results of combined gastroepiploic and internal thoracic artery bypass
T Isomura1, T Sato, K Hisatomi
1Second Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Insights
Combining internal thoracic artery (ITA) and gastroepiploic artery grafts in coronary artery bypass grafting (CABG) shows improved cardiac event-free rates up to 7 years. This arterial grafting strategy offers better long-term quality of life with minimal operative risk.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Internal thoracic artery (ITA) is the preferred conduit for coronary artery bypass grafting (CABG) due to low operative risk.
- Gastroepiploic artery grafting was introduced in 1987, with early results comparable to ITA grafts.
- This study presents intermediate-term results of combined ITA and gastroepiploic artery grafts up to 7 years post-CABG.
Purpose of the Study:
- To evaluate the intermediate-term efficacy and safety of using combined internal thoracic artery (ITA) and gastroepiploic artery grafts in coronary artery bypass grafting (CABG).
- To compare the outcomes of patients receiving CABG with ITA and gastroepiploic artery grafts versus those receiving ITA grafts alone or with saphenous vein grafts.
Main Methods:
- A cohort of 214 patients undergoing CABG between April 1988 and April 1992 with at least one ITA graft were followed for over 3 years.
- Group I (155 patients) received CABG with one ITA (with or without saphenous vein grafts).
- Group II (59 patients) received CABG with an ITA and a gastroepiploic artery (with or without saphenous vein grafts). Follow-up ranged from 36 to 89 months.
Main Results:
- Actuarial survival rates at 7 years were similar between groups (95.9% in Group I vs. 96.8% in Group II, p=NS).
- Cardiac event-free rates were significantly higher in Group II (92.2%) compared to Group I (75.4%, p < 0.05).
- Group II experienced fewer late cardiac deaths (1) and recurrent angina symptoms (2) compared to Group I (6 deaths, 13 angina cases).
Conclusions:
- Coronary artery bypass grafting (CABG) using both the internal thoracic artery (ITA) and gastroepiploic artery can be performed with minimal operative risk.
- This combined arterial grafting strategy appears to improve the quality of life for patients at least 7 years postoperatively.
- The use of combined ITA and gastroepiploic artery grafts demonstrates superior cardiac event-free survival compared to ITA grafts alone or with venous grafts.
Background:
To improve the postoperative results of coronary artery bypass grafting (CABG), the internal thoracic artery (ITA) has become the conduit of choice, with a low operative risk. The gastroepiploic artery as a third arterial conduit for grafting was first reported in 1987, and the early results were reported to be as good as those for the ITA graft. In this report, we present the intermediate-term results of combining ITA and gastroepiploic artery grafts up to 7 years after the operation.
Methods:
Between April 1988 and April 1992, 214 patients received CABG with at least one ITA graft and were followed up for more than 3 years. They were divided into two groups: Group I consisted of 155 patients who had CABG using one ITA with or without saphenous vein grafts, and group II consisted of 59 patients who had CABG using an ITA and a gastroepiploic artery with or without saphenous vein grafts. The duration of follow-up for hospital survivors ranged from 36 to 89 months.
Results:
There were six late cardiac deaths in group I and one in group II. Fifteen patients complained of recurrent symptoms of angina: 13 in group I and 2 in group II. The actuarial survival rate excluding noncardiac deaths was 95.9% in group I and 96.8% in group II at 7 years (p = not significant). The cardiac event-free rate was 75.4% in group I and 92.2% in group II, which was a significant difference (p < 0.05).
Conclusions:
When using both the ITA and gastroepiploic artery, CABG can be performed with minimal operative risk and seems to offer an improved quality of life at least 7 years postoperatively.