Sequential grafting of the right gastroepiploic artery in coronary artery bypass surgery

Ochi, Masami; Bessho, Ryuzo; Saji, Yoshiaki; Fujii, Masahiro; Hatori, Nobuo; Tanaka, Shigeo

doi:10.1016/s0003-4975(00)02703-x

Cited by 16 publications

(20 citation statements)

References 22 publications

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“…An RGEA with a diameter less than 2.0 mm is thought to be inappropriate as a graft for coronary artery bypass grafting [15][16][17]. Ochi et al [16] reported that the luminal diameter of the RGEA should be more than 2.6 mm to supply sufficient blood flow, using postoperative echocardiographic and angiographic evaluation.…”

Section: Discussionmentioning

confidence: 99%

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Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation

Lee

Kim

et al. 2010

Int J Cardiovasc Imaging

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To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) angiography for prediction of availability of the right gastroepiploic artery (RGEA) for coronary artery bypass grafting surgery (CABG). This study included 149 patients who underwent both preoperative MDCT angiography and exploratory laparotomy to harvest the RGEA for CABG. The prediction of availability of RGEA using the MDCT finding was evaluated by comparing it to an exploratory laparotomy evaluation of RGEA as a gold standard. The MDCT findings of atherosclerosis and diameter of the RGEA were analyzed. The atherosclerosis of other visceral branches was also analyzed for the detection of affecting factors to the availability for CABG. Atherosclerotic change of vessel was defined as findings including vessel wall calcification, luminal irregularity, aneurysmal change, and apparent atheroma. For statistical analysis, unpaired t-test and receiver operating curve analyses were used to compare the size of the RGEA, and the chi-square test was used to evaluate significant determinant factors of RGEA availability. In exploratory laparotomy, 21 out of 149 RGEAs were classified as inappropriate as a graft for CABG. The reason for inappropriateness was atherosclerosis of RGEA in 15 patients and small diameter in six patients. Sensitivity, specificity, positive predictive value and negative predictive value of MDCT angiography for assessing RGEA atherosclerosis was 60, 99.6, 94.7 and 96.1%, respectively. Atherosclerotic change of the RGEA itself was the only significant determinant factor for predicting the appropriateness of each RGEA. The mean diameter was 1.94 mm in 21 inappropriate RGEAs and 2.41 mm in 128 appropriate RGEAs. This difference was significant (P = 0.001). The least diameter of appropriate RGEA was 1.4 mm on MDCT angiography, and the cut-off value determined by ROC analysis was 1.8 mm with 82.8% of sensitivity and 61.9% of specificity for inappropriate RGEA, and the area under the curve value was 0.729. MDCT is useful preoperative evaluation tool for RGEA availability. Findings of atherosclerosis of the RGEA and a small diameter on MDCT angiography suggest inappropriateness of the RGEA for CABG surgery.

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Section: Discussionmentioning

confidence: 99%

“…Ochi et al [16] reported that the luminal diameter of the RGEA should be more than 2.6 mm to supply sufficient blood flow, using postoperative echocardiographic and angiographic evaluation. Our study results correlated well with these previous reports, except that the mean diameters of the RGEAs used were relatively smaller.…”

Section: Discussionmentioning

confidence: 99%

Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation

Lee

Kim

et al. 2010

Int J Cardiovasc Imaging

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“…Although a sequential b~pass is usually requested for multiple bypassing using GEA, the distal narrow part of the GEA is not suitable for grafting regarding graft patency. 6 Ochi and colleagues recommended the GEA should have a diameter of 2.6 mm or more, from dobutamine stress echocardiographical findings. They found that regions grafted with a GEA less than 2,6 mm showed frequent ischemia.…”

Section: Discussionmentioning

confidence: 99%

Beating heart coronary artery bypass grafting

Takemura

Watanabe

Takahashi

et al. 2003

Jpn J Thorac Caridovasc Surg

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A consecutive series of beating heart CABG was performed safely and effectively with a low mortality rate and low morbidity rate. Beating heart CABG could be performed in all patients, and definite off-pump CABG was accomplished in 95% of them. In order to aim for complete revascularization, GEA composite graft was found to be effective since it required a low mean number of 1.6 anastomoses and a satisfactory patency rate at the same time.

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“…When its length is long enough, the circumflex artery (CX) such as the obtuse marginal branch and posterolateral branch can be grafted by the RGEA. Ochi et al reported their series of sequential grafting using the RGEA 13 …”

Section: Methodsmentioning

confidence: 99%

“…Inadequate flow capacity leads to flow competition and affects graft patency. An RGEA with a small caliber less than 2.0 mm is thought to be inadequate as a conduit for bypass 13,19,20 . Ochi et al presented that the luminal diameter of the RGEA should be more than 2.6 mm to supply sufficient blood flow, using postoperative echocardiographic and angiographic evaluation 21 …”

Section: Methodsmentioning

confidence: 99%

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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Sequential grafting of the right gastroepiploic artery in coronary artery bypass surgery

Cited by 16 publications

References 22 publications

Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation

Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation

Beating heart coronary artery bypass grafting

The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

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