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Kazuyoshi Tajima
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J Thorac Cardiovasc Surg 2009;138:669-673
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Transit-time flow characteristics of in situ right gastroepiploic arterial grafts in coronary artery bypass grafting

Yoshiyuki Takami, MD*, Kazuyoshi Tajima, MD, Sachie Terazawa, MD, Noritaka Okada, MD, Kei Fujii, MD, Yoshimasa Sakai, MD

Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

Received for publication September 2, 2008; revisions received December 22, 2008; accepted for publication February 1, 2009.

* Address for reprints: Yoshiyuki Takami, MD, Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya 466-8650 Japan. (Email: takami{at}nagoya2.jrc.or.jp).

Objective: We investigated flow characteristics of right gastroepiploic arterial grafts, widely used to extend in situ arterial conduits in coronary artery bypass grafting.

Methods: Intraoperative transit-time measurements and postoperative angiographic findings were obtained for 111 patients undergoing coronary artery bypass grafting with gastroepiploic artery and bilateral internal thoracic arteries: mean, maximum, and minimum flows; pulsatility index; insufficiency rate; and differentiated index of early diastolic flow.

Results: Favored target for gastroepiploic artery was posterior descending artery (106 patients, 95%). Patency rates were 91.0% for gastroepiploic artery, 98.2% for left internal thoracic artery, and 97.5% for right internal thoracic artery. There were four flow profiles of gastroepiploic arteries: A (systolic protruded), B (trapezoidal), C (sine waved), and D (diastolic-dominant biphasic). Functional gastroepiploic arteries showed A in 16 cases, B in 6, C in 31, and D in 48, with prevalence according to severity of stenosis in target coronary artery. Two occluded gastroepiploic arteries showed type A, and reverse or competitive flows were types A in 1, B in 1, C in 4, and D in 2. Relative to functional internal thoracic arteries, functional gastroepiploic arteries showed significantly lower minimum flow, higher insufficiency rate, and lower differentiated index of early diastolic flow.

Conclusion: Intraoperative transit-time flow profiles of patent in situ gastroepiploic arterial grafts were classified into four types, closely associated with disease severity of target coronary artery. Patent in situ gastroepiploic arterial grafts show more regurgitant flow and lower differentiated index of early diastolic flow than in situ internal thoracic arterial grafts.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; dFormula /dt = differentiated index of early diastolic flow; GEA = right gastroepiploic artery; IR = insufficiency rate; ITA = internal thoracic artery; MLD = minimum luminal diameter; PDA = posterior descending coronary artery; PI = pulsatility index; Formula max = maximum graft flow; Formula mean = mean graft flow; Formula min = minimum graft flow; RCA = right coronary artery






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