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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 826-831, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BW Lytle, DM Cosgrove, NB Ratliff and FD Loop
The excellent results of coronary artery bypass with the internal mammary
artery and the increasing numbers of patients who need coronary
reoperations, but for whom conventional bypass conduits are not available,
have prompted us to evaluate alternative arterial bypass conduits. The
right gastroepiploic artery has been used as a coronary bypass graft in 36
patients (32 men), whose ages ranged from 29 to 71 years. Twenty-two
patients had had previous coronary bypass grafting and six of these were
undergoing their third bypass operation. The right gastroepiploic artery
was used as an in situ graft to the right coronary artery or circumflex
branches for 17 patients and as an aorta- coronary ("free") graft in 19
patients, six to the left anterior descending or diagonal, six to the
circumflex, and seven to the right coronary artery. In conjunction with
right gastroepiploic artery grafting, 16 patients received bilateral
internal mammary artery grafts and 17 received one internal mammary artery
graft. Histologically, right gastroepiploic artery segments from 18
patients could not be distinguished from internal mammary artery segments,
and no evidence of atherosclerosis was found. Two patients died in the
hospital, one intraoperatively and one 3 months after the operation, of a
perioperative stroke. Perioperative morbidity included wound complication
in three and reexploration for bleeding in two. At late follow-up 1 to 38
months after operation, two late deaths had occurred and 21 patients were
free of symptoms. Postoperative angiography (postoperative interval 1 week
to 13 months) was performed in nine grafts, three in situ grafts to the
right coronary artery and six free grafts that included two to the left
anterior descending, three to the circumflex, and one to the right coronary
artery. All right gastroepiploic artery grafts were patient. The right
gastroepiploic artery is an arterial conduit that can be used as an in situ
graft to posterior coronary vessels and as a free graft to any coronary
arterial system. Early graft patency has been excellent, and the histologic
similarity between the right gastroepiploic artery and the internal mammary
artery suggest that the long-term results will be favorable.
ARTICLES
Coronary artery bypass grafting with the right gastroepiploic artery
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
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