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[The gastroepiploic artery graft in coronary artery bypass surgery]
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
The right gastroepiploic artery (GEA) demonstrates excellent patency and offers advantages for coronary artery bypass grafting (CABG), showing comparable results to the internal thoracic artery (ITA). This study highlights GEA as a promising arterial conduit for CABG procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Innovation
Context:
- Coronary artery bypass grafting (CABG) remains a cornerstone treatment for severe coronary artery disease.
- The selection of appropriate arterial conduits is crucial for long-term graft patency and patient outcomes.
- The right gastroepiploic artery (GEA) has emerged as a potential alternative arterial graft.
Purpose:
- To evaluate the efficacy and outcomes of using the right gastroepiploic artery (GEA) as a conduit in coronary artery bypass grafting (CABG).
- To compare the early patency rates of GEA grafts with those of the internal thoracic artery (ITA) grafts.
- To identify the advantages and potential limitations of GEA utilization in CABG surgery.
Summary:
- A study involving 91 patients undergoing CABG utilized the right gastroepiploic artery (GEA), often in conjunction with the internal thoracic artery (ITA).
- The GEA demonstrated a high early patency rate of 97%, comparable to the ITA, with most grafts used in situ for the right coronary arteries.
- The procedure achieved significant angina relief in 98% of survivors, with low early mortality and favorable graft performance.
Impact:
- The right gastroepiploic artery (GEA) presents a viable and effective arterial conduit for coronary artery bypass grafting (CABG), offering comparable patency to the internal thoracic artery (ITA).
- GEA's characteristics, including size compatibility, resistance to arteriosclerosis, and feasibility for in situ grafting, position it as a promising option for improving CABG outcomes.
- Further research into the long-term patency of GEA grafts is warranted to fully establish its role in revascularization strategies.
Abstract:
From March 1986 to October 1989, 91 patients underwent CABG using the right gastroepiploic artery (GEA) at Osaka Medical College and Mitsui Memorial Hospital. Including 14 females, the mean age was 57.9 years old ranged from 34 to 73 years old. Triple vessel disease and left main disease occupied over 90% of the patients. There were 5 emergency operations and 6 reoperations. Associated serious diseases were; renal failure with hemodialysis in 2 pts., familial hyperlipidemia in 5 pts., severe atherosclerotic ascending aorta in 8 pts., arteriosclerosis obliterance in 3 pts., and each one of abdominal aortic aneurysm and idiopathic thrombocytopenic purpura. The internal thoracic artery (ITA) graft was concomitantly utilized in 96% of the patients. Single ITA in 60 pts., double ITA in 23 pts. and sequential ITA in 5 patients. Saphenous vein graft was used in 58 patients and remaining 33 patients were operated without leg wound. The mean number of distal anastomoses was 3.3 ranged from 1 to 5, and the mean number of arterial grafts was 2.5 ranged from 1 to 4. The mean aortic cross clamp time and cardiopulmonary bypass time was 62.8 minutes and 113.6 minutes, respectively. Sites of GEA anastomosis were; 4 anterior descending, 3 diagonal, 11 circumflex and 73 right coronary arteries. There were 86 in situ grafts mostly for the right coronary arteries, and remaining 5 GEAs were used as a free graft to bypass the left coronary arteries. On the contrary, ITA was used to bypass the left coronary artery system preferentially. There was 3 combined procedures; splenectomy, abdominal aorta replacement, and ascending aorta to bifemoral artery bypass in each one patients. Three patients including one emergency case died within 30 days after surgery. Two were cardiac and one was renal failure. Other 2 patients died of stroke at late period. New Q wave infarction was noted in 2 patients. Relief of angina was obtained in 98% of survivors. The patency rate of the GEA graft was 97% in 61 grafts restudied within 6 postoperative months, which was identical with that of the ITA graft, that is 97% of 76 grafts. In conclusion, the GEA has several advantages as a coronary artery bypass graft such as similarity in size to the coronary artery, rare arteriosclerosis, feasibility of in situ graft, and no gastric complication. Its flow capacity is studying now and favourable results are being obtained. The final problem, its long term patency, will be resolved in future. GEA is a promising conduit for the coronary bypass surgery.