Transplantation of the en bloc vascular system for coronary revascularization

Matsuura, Akio; Yasuura, K; Yoshida, Katsuhiko; Oshima, Hideki; Tomari, Shiro; Ishida, Hideki; Mori, Satsuki; Fujii, Genyo; Iwata, Kazunori

doi:10.1067/mtc.2001.112624

Cited by 12 publications

(10 citation statements)

References 9 publications

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“…The early patency rate of the RGEA was 91.8 to 100% 4,6,13,18,29,32,34,43,50 when used as an in situ graft or as inflow of a composite graft, as shown in Table 1. When the RGEA was used as a free graft, it ranged from 70% to 100%, 33,54,83 as shown in Table 2. Reports of LITA-RGEA composite graft are rare.…”

Section: Resultsmentioning

confidence: 99%

“…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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Spasm Of Rgeamentioning

confidence: 99%

The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

Sasaki

2008

Journal of Cardiac Surgery

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“…Of these, and aside from the RGEA, only atherosclerosis of the splenic artery showed a tendency to correlate with an inappropriate RGEA. However, when the RGEA is used as in situ graft for the revascularization of the posterior descending artery [14], atherosclerotic change of the proximal portion of the RGEA is possibly important, and in such cases, atherosclerotic change of the celiac axis or gastroduodenal artery must be considered for the assessment of appropriateness of the RGEA for coronary artery bypass grafting.…”

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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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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“…27) As in situ arterial grafts, GEA is secondary to the internal mammary artery. 28) Moreover, RAG 29) and free-GEA 20) have been applied clinically. We investigated 43 patients with 114 coronary artery bypass grafts including LIMA, RIMA, GEA, RAG, and free-GEA by EBA.…”

Section: Discussionmentioning

confidence: 99%

“…18) EBA images scanned at the former phase of the cardiac cycle are apt to be distorted by movement of the coronary arteries associated with cardiac contraction. In this study, we adopted the latter phase by referring to the recent paper 19) by Mao, et al We evaluated the diagnostic accuracy of EBA for determining the patency of 114 coronary artery bypass grafts including not only saphenous vein grafts (SVG) and left internal mammary artery grafts (LIMA), but also right internal mammary artery grafts (RIMA), gastroepiploic artery grafts (GEA), free gastroepiploic artery grafts with venous drainage (free-GEA), 20) and free radial artery grafts (RAG). We discuss the usefulness and limitations of this method.…”

Section: Arteriesmentioning

confidence: 99%

Noninvasive Detection of Coronary Artery Bypass Graft Patency by Intravenous Electron Beam Computed Tomographic Angiography.

et al. 2003

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SUMMARYThis study evaluates the usefulness of intravenous electron beam computed tomographic angiography (EBA) for the detection of coronary artery bypass graft patency in 43 patients (33 men and 10 women, mean age, 65 years) who had coronary artery bypass graft surgery. EBA was performed a few days before selective bypass graft angiography (SGA). Forty axial cross-sections of angiographic images of the heart were acquired consecutively by an electrocardiographic trigger signal at 40% of the RR interval, which corresponds to the end-systolic phase. EBA data were reconstructed as a three-dimensional shaded surface display of the heart and bypass grafts. Detectability of the patency of bypass grafts was evaluated, taking selective angiographic images of the bypass grafts as a gold standard. One hundred and nine grafts (96%) out of 114 grafts were subjected to evaluation: 37 grafts were left internal mammary artery grafts (LIMA), 7 were right internal mammary artery grafts (RIMA), 6 were gastroepiploic artery grafts (GEA), 7 were free gastroepiploic artery grafts with venous drainage (free-GEA), 7 were radial artery grafts (RAG), and 45 were saphenous vein grafts (SVG). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBA were 98%, 100%, 100%, 91%, and 98%, respectively. EBA sampled at the end-systolic period was determined to be useful for the detection of coronary artery bypass graft patency and occlusion. (Jpn Heart J 2003; 44: 811-822) Key words: Electron beam computed tomography, Coronary artery bypass grafting, Angiography POSTOPERATIVE angina occurs with a frequency of 30% in the first year after coronary artery bypass graft (CABG) surgery.1) It may result from either graft occlusion, or progression of the atherosclerotic lesion of the native coronary From the

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Transplantation of the en bloc vascular system for coronary revascularization

Abstract: The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate.

Cited by 12 publications

References 9 publications

The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

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

Noninvasive Detection of Coronary Artery Bypass Graft Patency by Intravenous Electron Beam Computed Tomographic Angiography.

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