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[Mid-term results in coronary revascularization using the right gastroepiploic artery graft]
Insights
Coronary artery bypass grafting using the right gastroepiploic artery (REGA) shows good early and mid-term results, including high survival and graft patency rates. However, potential issues like flow competition and gastric cancer require consideration.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Oncology
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease.
- The right gastroepiploic artery (REGA) is an alternative conduit for CABG, offering potential benefits.
- Evaluating the long-term efficacy and safety of REGA in CABG is essential for clinical practice.
Purpose of the Study:
- To assess the mid-term postoperative outcomes of CABG utilizing the right gastroepiploic artery (REGA).
- To analyze mortality, survival rates, graft patency, cardiac events, and abdominal complications associated with REGA-CABG.
Main Methods:
- A retrospective study of 191 patients undergoing CABG with REGA, with a mean follow-up of 37 months.
- Evaluation of outcomes including mortality, survival, graft angiography, cardiac event-free rates, and abdominal complications.
- Analysis of early and mid-term patency rates and graft performance via angiography.
Main Results:
- Overall survival rates were 94.2% at 1 year, 90.0% at 3 years, and 85.9% at 5 years.
- Early REGA patency was 98.9%, with a mid-term patency of 96.4%.
- Flow competition occurred in 24.0% of cases, and long-term abdominal complications included incisional hernia and gastric cancer.
Conclusions:
- Early and mid-term results of CABG using REGA are favorable, with good survival and graft patency.
- Potential challenges include flow competition with native coronary arteries and the long-term risk of gastric cancer.
- REGA is a viable option for CABG, but careful patient selection and monitoring are warranted.
Abstract:
We studied the mid-term results in 191 patients (including emergent operation in 27 patients) who have performed coronary artery bypass grafting (CABG) using the right gastroepiploic artery (REGA) for 74 months (mean follow up period was 37 months). We evaluated the postoperative results in terms of 1. mortality and survival rate, 2. graft angiography, 3. cardiac event free rate and 4. abdominal complications. We had operative death in 6 patients (3.1%) including 3 patients of emergent operations. Late deaths were found in 11 patients (5.9%): 2 patients were cardiac death and 9 were non-cardiac. The actual survival rates were 94.2% at one year, 90.0% at three years and 85.9% at five years. Early patency rate of the RGEA was 98.9% (n = 178). However flow competition between the RGEA and native coronary artery was seen in 42 patients (24.0%). Mid-term patency rate was 96.4% (n = 28). According to mid-term graft angiography, 1 patient improved and 5 patients got worse in comparison with early control. Cardiac event free rates were 98.2% at 1 year, 94.8% at 3 years and 92.7% at 5 years. Abdominal complications were observed in 5 patients (1 patient of bleeding from the RGEA, 1 of gastric perforation, 2 of bleeding from gastric ulcer and 1 of pyloric stenosis) at early period and in 7 patients (2 patients of incisional hernia and 5 of gastric cancer) at long-term period. Early and mid-term results of CABG using the RGEA were quite good. However, the RGEA had a tendency of flow competition against native coronary artery and a problem of gastric cancer after the operation.