Twenty Years Experience With the Gastroepiploic Artery Graft for CABG

Abstract

Background-To improve the longterm outcome after CABG, several strategies have been used using arterial conduits.Our 20 years experience with the right gastroepiploic artery (GEA) graft was evaluated. Methods and Results-In 1352 patients having CABG with the GEA graft, (1092 men, mean 63 years, 99% multivessel disease, and mean EF 0.51), internal thoracic artery, saphenous vein, and radial artery grafts were concomitantly used in 1312 (97%), 783 (58%), and 128 (8%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites for GEA grafting were 70 anterior descending, 268 circumflex, and 1089 right coronary arteries. The operative mortality was 1.26%. In 1118 follow-up patients (82.6%), 5, 10, and 15 years survival rates were 91.7%, 81.4%, and 71.3%, and the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 97.1% at 1 month, 92.3% at 1 year, 85.5% at 5 years, and 66.5% at 10 years, respectively. In 172 skeletonized GEA grafts with 233 distal anastomoses, the patency rate at immediate, 1, and 4 years after surgery was 97.6%, 92.9%, and 86.4%, respectively. In 124 patients with late (5 to 17 years) restudy, patency rate was 96% (114/119) in the left internal thoracic artery, 87% (108/124) in GEA, and 68% (67/98) in saphenous vein grafts. New stenosis was uncommon in GEA. Conclusion-The

Modern trends in coronary surgery

“…Как показал H. Suma, имеющий, пожалуй, наибольший опыт ПЖ-СА-коронарного шунтирования, периоперационные осложнения и смертность при ее применении не пре-вышает обычных, а осложнения, связанные с лапарото-мией, минимальны. В 1993 г. H. Suma сообщил о хоро-ших клинических и ангиографических промежуточных результатах применения ПЖСА у 200 больных, а при анализе 20-летнего опыта выявил, что проходимость этих шунтов через 1 год -92%, через 5 лет -85% и через 10 лет после операции -66% [42].…”

Coronary artery bypass grafting in diabetic patients: Should we still use the saphenous vein graft? A review of literature in the past 15 years

“…Several studies demonstrated similarities of this conduit with the internal thoracic artery. Of the other possible arterial conduits, the right gastroepiploic artery (r-GEA) has several advantages, such as providing a comparably sized artery-to-artery anastomosis, necessitating no additional incision in the leg or forearm, and histologic similarity to the ITA, which would suggest long-term patency [57,58].…”

“…Suma, et al, in a study published on Circuation [57], a large series of patients who recived a r-GEA graft, demonstrating that r-GEA has a patency rate superior to the SV one.…”

Off-pump Coronary Artery Bypass Grafting as Re-do Surgery in Two Cases in Which the Right Gastroepiploic Artery Was Grafted to the Right Coronary Artery

“…[8][9][10] In a follow-up study from 5-17 years, Suma et al reported that graft patency rates were as high as 87% (108/124).…”