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Ann Thorac Surg 2001;71:1209
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 3108 Queeny Tower, St. Louis, MO 63110, USA

e-mail: barnerh{at}msnotes.wustl.edu

The authors have failed to cite the most recent paper by Suma and colleagues [1] which provides 10 year gastroepiploic artery (GEA) patency of 62.5% and saphenous vein patency of 68%. These data remove some luster from the GEA as a conduit. It must also be noted that the right internal thoracic artery has a 10 year patency of 75% when grafted to the posterior descending artery as reported by Buxton and colleagues [2].

Nevertheless, this is the first report of the GEA as a sequential graft and one which provides midterm angiographic follow-up results that are excellent. In addition, the authors provide insightful guidelines for use of this conduit. They emphatically state that the GEA should only be used as a sequential graft if the diameter at the estimated site of the distal anastomosis is greater than 2.0 mm. Thus, angiographic assessment of the GEA is necessary. Additionally the GEA has significant variability in its size (diameter and length). Therefore it may be unable to deliver adequate flow to a large right coronary system and it is also more vulnerable to competitive coronary flow. The authors point out that these anatomic limitations of the GEA are the greatest reason for its restricted use in their experience. The authors also use a skeletonized conduit which has been my usage for a decade.

The internal thoracic artery and the radial artery do not require angiographic assessment in my experience. Use of the GEA requires some planning, but it remains a useful in situ conduit whose utility has been expanded by this report.

References

1. Suma H., Isomura T., Horii T., Sato T. Late angiographic result of using the right gastroepiploic artery as a graft. J Thorac Cardiovasc Surg 2000;120:496-498.[Abstract/Free Full Text]
2. Buxton B.F., Ruengsakulrach P., Fuller J., et al. The right internal thoracic artery graft—benefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Cardiothorac Surg 2000;18:255-261.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hendrick B. Barner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Barner, H. B. Search for Related Content PubMed Articles by Barner, H. B. Related Collections Coronary disease Related Article