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The Annals of Thoracic Surgery, Vol 47, 706-711, Copyright © 1989 by The Society of Thoracic Surgeons
NL Mills and CT Everson
Experience with 39 patients (32 men, 7 women) undergoing coronary artery
bypass grafting with the right gastroepiploic artery (RGEA) is reported.
Indications initially included poor-quality or absent saphenous vein,
ascending aortic atherosclerosis, and repeat coronary artery bypass
grafting. The average number of grafts per patient was 4.10. Arteries
bypassed were the posterior descending (22 patients), right coronary (12),
diagonal (5), and marginal (4). Distal RGEA internal diameters of all
grafts measured 1.5 to 3.25 mm (average diameter, 2.14 mm). Pedicled graft
lengths measured 18 to 30 cm (average length, 23.7 cm), and free grafts, 8
to 24 cm (average length, 17.7 cm). In 6 patients, no vein grafts were
used, and in all patients, at least one internal mammary artery graft was
placed. Early postoperative cardiac catheterization (19 pedicled and ten
free grafts) in 29 patients revealed all grafts to be patent without a kink
or twist, but three of these free RGEA grafts had vasospasm. Advantages of
RGEA grafts are as follows: (1) it is a third arterial conduit with
artery-artery anastomoses of comparable sizes; (2) a shorter leg incision
or no leg incision is necessary; (3) it can be harvested simultaneously
with the internal mammary artery and the saphenous vein; (4) the proximal
anastomosis (free grafts) is easy; (5) its use avoids bilateral internal
mammary artery grafts in patients at high risk for sternal infection; and
(6) atherosclerotic ascending aortas are not clamped. Subintimal
hyperplasia and atherosclerosis of RGEA grafts are unlikely.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Right gastroepiploic artery: a third arterial conduit for coronary artery bypass
Department of Surgery, Cardiology Center, New Orleans, Louisiana.
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