Myocardial Revascularization with the Gastroepiploic Artery

Abstract

Between July, 1990, and January, 1992, 21 consecutive patients underwent myocardial revascularization with the use of the right gastroepiploic artery, among other grafts. They were 20 men and 1 woman, with a mean age of fifty-five years (range: thirty-seven to seventy). Previous myocardial infarction was present in 44% of patients, unstable angina in 81%, and three-vessel disease in 75%. Mean ejection fraction was 54% (range 45-67%). Two patients had had previous coronary bypass surgery. In 20 patients one or both internal mammary arteries or sequential grafts with the left internal mammary artery were used. Overall 63 coronary grafts were performed (mean 3 grafts per patient). Of these, 81% were arterial grafts and 19% saphenous vein grafts. Gastroepiploical grafts were to the following branches: posterolateral branch, 3 patients; posterior descending artery, 11; right coronary artery, 6; and the left anterior descending artery, 1 patient. Mean aortic crossclamp time was seventy-four minutes. Mean total drainage was 1600 cc. The incidence of perioperative acute myocardial infarction was 9.5%. Overall hospital mortality was represented by 2 patients, 9.5%. Mortality in primary revascularization was represented by 1 patient, 5%. The authors studied the graft patency with digital subtraction angiography and contrast injection in the celiac trunk. This was accomplished in 16 survivors (84% of total). The graft was patent in 14 patients (87%) and in 2 patients (13%) incomplete visualization of the graft was obtained. The authors conclude that the gastroepiploic artery offers a valid alternative for the revascularization of the branches of the diaphragmatic wall of the heart. It can be accomplished with low mortality and good immediate results.