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Minimally invasive coronary artery bypass grafting using the right gastroepiploic artery
S Voutilainen1, K Verkkala, A Järvinen
1Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Insights
Minimally invasive coronary artery bypass grafting can be expanded to two-vessel disease using the right gastroepiploic artery (RGEA) and left internal thoracic artery (LITA). This approach shows high graft patency for treating left anterior descending artery and right coronary artery lesions.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Coronary Artery Bypass Grafting
Background:
- Left internal thoracic artery (LITA) to left anterior descending (LAD) artery anastomosis is standard for minimally invasive coronary artery bypass grafting (CABG).
- Expansion to two-vessel disease necessitates additional graft options beyond LITA.
- Right gastroepiploic artery (RGEA) to right coronary artery (RCA) anastomosis is explored for this purpose.
Purpose of the Study:
- To evaluate the feasibility and efficacy of using RGEA for coronary artery bypass grafting in patients with two-vessel disease.
- To determine graft patency rates for RGEA and LITA in minimally invasive CABG.
Main Methods:
- Retrospective analysis of 100 minimally invasive CABG patients from February to November 1996.
- RGEA used in 25 patients for RCA revascularization, often combined with LITA for LAD.
- Angiography performed postoperatively to assess graft patency.
Main Results:
- 82.6% of RGEA grafts and 100% of LITA grafts were patent postoperatively.
- RGEA graft patency was 95% in cases without competitive flow from the native RCA.
- Non-critical RCA stenosis explained patency failure in some RGEA grafts.
Conclusions:
- Minimally invasive CABG indications can be extended to patients with LAD and RCA lesions.
- Combined use of LITA and RGEA is a viable option for two-vessel disease.
- This technique expands treatment options for complex coronary artery disease.
Background:
Anastomosis of the left internal thoracic artery to the left anterior descending artery without sternotomy and without cardiopulmonary bypass is a standard approach in minimally invasive coronary artery bypass grafting. To expand the indications for minimally invasive coronary artery bypass grafting from one-vessel disease to two-vessel disease, we began to perform anastomosis of the right gastroepiploic artery (RGEA) to the right coronary artery (RCA).
Methods:
From February to November 1996, an RGEA graft was used in 25 of the 100 patients who underwent minimally invasive coronary artery bypass grafting at our clinic. Eleven of the patients had only RCA disease and 14 had both RCA and left anterior descending artery disease. One of the operations was a redo coronary artery bypass grafting. The RGEA was anastomosed to the RCA through a laparotomy incision and the left internal thoracic artery was anastomosed to the left anterior descending artery through a left anterior thoracotomy. In 5 patients, the RGEA was lengthened by venous grafting.
Results:
All patients underwent angiography after operation; 82.6% of the RGEA grafts and all the left internal thoracic artery grafts were functioning well. In three of the four nonvisualized RGEA grafts, the percentage of proximal stenosis of the RCA seen on postoperative angiography was not critical (40%, 50%, and 50%, respectively), allowing significant competitive flow through the native bypassed RCA. The patency of all the RGEA grafts without competitive flow was 95%, with a 95% confidence interval of 75.1% to 99.9%.
Conclusions:
The indications for minimally invasive coronary artery bypass grafting could be extended to primary operations in patients with left anterior descending artery and RCA lesions by using both the left internal thoracic artery and the RGEA.