Letter

Sequential bypass using the right gastroepiploic artery for coronary artery bypass grafting

OBJECTIVE

Since 1989, we have applied the right gastroepiploic artery (RGEA) as a third arterial conduit for coronary artery bypass grafting (CABG) and started to use sequential RGEA in 1992. We evaluated the feasibility and efficacy of sequential RGEA grafting in CABG.

METHODS

From December 1990 to January 2000, 46 patients underwent CABG with sequential RGEA. There were 42 male and 4 female patients with a mean age of 59 +/- 8.1 years. Mean postoperative follow-up period was 70 months.

RESULTS

The mean number of anastomoses was 3.7 per patient. Mean luminal diameter of the RGEA was 2.2 +/- 0.4 mm by preoperative angiography and 2.3 +/- 0.6 mm by intraoperative measurement. Patency of the sequential RGEA was 92%; proximal anastomosis 100%, distal anastomosis 86% (p = 0.01). The 5-year actuarial survival and cardiac event-free rate were 91% and 93%, respectively.

CONCLUSIONS

Sequential bypass using the RGEA is feasible, with excellent early and long-term results. The indication for sequential RGEA, however, needs careful anatomical consideration of both the luminal diameter of the RGEA and proximal stenosis of the target coronary arteries.

Arterialization in coronary artery surgery in Japan and Hong Kong

In the 35 years of coronary artery bypass grafting, several kinds of conduits have been utilized and assessed. It is clear now that the saphenous vein graft deteriorated with time mainly due to atherosclerosis in the graft called "vein graft disease." The internal thoracic artery graft, on the contrary, stays patent very well in the long-term period and this evidence directly related to the superior later outcome in terms of longevity and postoperative cardiac events. To extend the use of arterial conduits for myocardial revascularization, several autologous arteries have been investigated and utilized clinically. With proper use of these new arterial conduits in addition to internal thoracic artery, coronary artery bypass grafting with multi-arterial grafts can be performed safely, and better long term result can be expected.

Arterial grafts for coronary artery bypass grafting: biological characteristics, functional classification, and clinical choice

Various arterial grafts have been used for coronary artery bypass grafting, but a unanimous opinion on how to best use these grafts has not been formed. Arterial grafts are not uniform in their biological characteristics. Differences between the perioperative behavior of the grafts and their long-term patency may be related to different characteristics. These characteristics should be taken into account in the use of arterial grafts, some of which are subject to more active pharmacologic intervention during and after operation to obtain satisfactory results. Clinical choice of grafts must be based on the general condition of the patient, the biological characteristics of the graft, the anatomy of the coronary artery, the match between the coronary artery and the graft, and technical considerations, including antispastic management.