Midterm Results for Use of the Skeletonized Gastroepiploic Artery Graft in Coronary Artery Bypass

Suma, Hisayoshi; Tanabe, Hiroaki; Yamada, Junya; Mikuriya, Akiyoshi; Horii, Taiko; Isomura, Tadashi

doi:10.1253/circj.71.1503

Cited by 20 publications

(18 citation statements)

References 10 publications

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“…The proximal portion of the GEA usually measures 2.5 to 3 mm in diameter and in most cases remains greater than 1.5 mm in the middle of the greater curvature. Suma and colleagues, in their experience with GEA grafting, describe a 5-year patency rate of 85.5% [36], implying a significant durability of the GEA graft, which seems to have a low incidence of atherosclerosis and sufficient flow capacity to be used as CABG [36, 37]. The in situ GEA easily reaches the inferior wall of the myocardium without stretching and appears particularly suitable for anastomosis to the posterior descending artery or to the proximal right coronary artery [38].…”

Section: Gastroepiploic Arterymentioning

confidence: 99%

Contemporary use of arterial and venous conduits in coronary artery bypass grafting: anatomical, functional and clinical aspects

et al. 2016

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Although the benefits of using the left internal mammary artery to bypass the left anterior descending artery (LAD) have been extensively ascertained, freedom from major cardiovascular events and survival after coronary artery bypass grafting (CABG) also correlate with the completeness of revascularisation. Hence, careful selection of the second-best graft conduit is crucial for CABG success. The more widespread use of saphenous vein grafts contrasts with the well-known long-term efficacy of multiple arterial grafting, which struggles to emerge as the procedure of choice due to concerns over increased technical difficulties and higher risk of postoperative complications. Conduit choice is at the discretion of the operator instead of being discussed by the heart team, where cardiologists are not usually engaged in such decisions due to a hypothetical lack of technical knowledge. Furthermore, according to the ESC/EACTS guidelines, traditional CABG remains the gold standard for multi-vessel coronary artery disease with complex LAD stenosis, but hybrid procedures using percutaneous coronary intervention for non-LAD targets could combine the best of two worlds. With the aim of raising the cardiologist’s awareness of the surgical treatment options, we provide a comprehensive overview of the anatomical, functional and clinical aspects guiding the decision-making process in CABG strategy.

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Section: Gastroepiploic Arterymentioning

confidence: 99%

Contemporary use of arterial and venous conduits in coronary artery bypass grafting: anatomical, functional and clinical aspects

et al. 2016

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“…The GEA is also prone to flow competition compared with the LITA because the GEA is the third branch of the abdominal aorta and has 10-15 mmHg lower pressure at its end compared with the end of the LITA. [35][36][37] Although skeletonized and composite use of the GEA for larger internal diameter and flow has been reported, 38 avoiding flow competition has not been proved. [39][40][41] The IEA was first reported as an alternative arterial graft to the SV in 1990.…”

Section: Advantage Of Ra Usementioning

confidence: 99%

Radial Artery as a Graft for Coronary Artery Bypass Grafting

Kobayashi

2009

Circ J

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“…Many surgeons have been using papeverine externally or intraluminally to relieve spasm when harvesting the RGEA. 19,23,[28][29][30][31][32][33][34][35][36][37][38] Hirose et al mentioned that the RGEA can be dilated from 1.5 mm to 2.0 mm to 2.5 mm by papaverine injection. 19 Formica et al used glyceryl-verapamil solution as well as papaverine.…”

Section: Spasm Of Rgeamentioning

confidence: 99%

“…The main target of the RGEA is the RCA, 4,[18][19][20][28][29][30]32,34,41,43,[45][46][47][48] especially its distal part. 19,20,23,30,32,41,45,47 The CX is a possible target when the graft is long enough.…”

Section: Distal Anastomosis Of Rgeamentioning

confidence: 99%

“…Although bilateral use of the ITA has been shown to improve the long-term clinical outcome, some patients who have potential risk factors for sternal wound Ochi et al 13 28/28 (100%) 61/61 (100%) Suma et al 28 1/1 (100%) 10/10 (100%) 79/81 (97.5%) 152/156 (97.4%) Esaki et al 29 1/1 (100%) 64/64 (100%) 38/38 (100%) Tabata et al 6 1/1 (100%) 23/23 (100%) Takahashi et al 14 24/25 (96%) 18/18 (100%) Takahashi et al 56 17/17 (100%) Suma et al 84 32/33 (97%) LAD = left anterior descending artery. CX = circumflex artery.…”

Section: Commentsmentioning

confidence: 99%

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The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

Sasaki

2008

Journal of Cardiac Surgery

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The right gastroepiploic artery (RGEA) has been used as a conduit in coronary artery bypass grafting. Although some reports presenting good results justify its use in clinical settings, there is still much concern about using the RGEA in bypass surgery. The RGEA demonstrates different behaviors from the internal thoracic artery (ITA) in bypass surgery due to its histological characteristics and anatomical difference, which might contribute to the long-term outcome. Now that left ITA (LITA) to left anterior descending artery (LAD) is the gold standard, other grafts are expected to cover the rest of the coronary arteries. It should be elucidated how we can use other grafts and what we can expect from them. RGEA, as an arterial graft, can be used as an in situ graft or a free graft. The RGEA is mainly used to graft to the right coronary artery (RCA) because of its anatomical position, and its patency is not inferior to that of the saphenous vein (SVG). The RGEA can cover the lateral walls when its length is long enough or by making a composite graft with other grafts. However, when used to graft to the LAD, its mid-term patency is not favorable.

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Midterm Results for Use of the Skeletonized Gastroepiploic Artery Graft in Coronary Artery Bypass

Cited by 20 publications

References 10 publications

Contemporary use of arterial and venous conduits in coronary artery bypass grafting: anatomical, functional and clinical aspects

Contemporary use of arterial and venous conduits in coronary artery bypass grafting: anatomical, functional and clinical aspects

Radial Artery as a Graft for Coronary Artery Bypass Grafting

The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

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