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J Thorac Cardiovasc Surg 2001;121:520-525
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Transplantation of the en bloc vascular system for coronary revascularization

From the Division of Cardiovascular Surgery, Cardiovascular Center, Aichi Prefectural Owari Hospital, Ichinomiya, Japan.

Received for publication June 15, 2000. Revisions requested Sept 29, 2000; revisions received Oct 27, 2000. Accepted for publication Oct 30, 2000. Address for reprints: Akio Matsuura, MD, Division of Cardiovascular Surgery, Cardiovascular Center, Aichi Prefectural Owari Hospital, 2135 Kariyasuka, Yamato-cho, Ichinomiya, Aichi 491-0934, Japan.

Objectives: Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting.
Methods: From January 1997 to October 1999, 33 patients underwent coronary artery bypass grafting with the free gastroepiploic artery according to our new method. The gastroepiploic artery graft was harvested en bloc with its satellite veins. The gastroepiploic vein was anastomosed to the right atrial appendage for venous drainage simultaneously with the gastroepiploic artery being grafted in the aortocoronary position.
Results: A total of 96 distal anastomoses were performed, including 33 free gastroepiploic artery grafts according to our method, 33 in situ left internal thoracic artery grafts, 26 saphenous vein grafts, and 4 radial artery grafts. Neither operative nor hospital death occurred. Early postoperative angiography revealed that all of the 33 free gastroepiploic artery grafts performed with our method were patent without spasm, and flow competition occurred only in 2 of those grafts. On late angiography, all 15 free gastroepiploic artery grafts were patent without spasm.
Conclusions: The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate.

This article has been cited by other articles:

				T. Eda, A. Matsuura, K. Miyahara, H. Takemura, S. Sawaki, T. Yoshioka, and N. Yoshida Transplantation of the Free Gastroepiploic Artery Graft for Myocardial Revascularization: Long-Term Clinical and Angiographic Results Ann. Thorac. Surg., March 1, 2008; 85(3): 880 - 884. [Abstract] [Full Text] [PDF]

				T. Eda, A. Matuura, K. Miyahara, H. Takemura, S. Sawaki, T. Yoshioka, and N. Yoshida Spontaneous Restoration of Patency in the Free Gastroepiploic Artery Graft: The Living Transplanted Vascular System for Coronary Revascularization Ann. Thorac. Surg., June 1, 2007; 83(6): 2219 - 2220. [Abstract] [Full Text] [PDF]

				K. Yasuura, H. Okamoto, and A. Matsuura Right gastroepiploic artery for coronary artery bypass grafting: a word of caution: Reply Ann. Thorac. Surg., December 1, 2001; 72(6): 2184 - 2185. [Full Text] [PDF]