Interval Results with Right Gastroepiploic Bypass
Objective: Right gastroepiploic artery bypass grafting has proved to be a viable surgical choice since the mid-1980s. Long-term graft patency, however, has been challenged ever since. We present 43 patients who underwent right gastroepiploic artery bypass surgery off pump with minimal invasive techniques with an average follow-up period of 57.9 months since 1996.
Methods: Operative methods are described and were confined to a subxiphoid incision. The series consists of 43 patients (38 male and 5 female) with an age range of 44 to 79 years. All patients had heart disease classified as Canadian Cardiovascular Society class III-IV and 35/43 (81.3%) of patients had undergone 1 to 3 reoperations. Postoperatively, 93% had no complications. Crude mortality was 2.3%, with an expected mortality of 4% and risk-adjusted mortality of 1.45%. Nine patients underwent combined procedures.
Results: Of the 43 patients, 41 were alive at 57.4 months (range, 20-76 months). Results of Doppler studies and angiography proved 95.3% and 91.6% patency.
Conclusion: In this series, our highest-risk patients with reoperative coronary artery disease had low mortality and no intervention in this interval follow-up.
Akhter M, Lajos, T, Grosner G, Bergsland J, Salerno T. 1997. Reoperations with the right gastroepiploic artery without cardiopulmonary bypass. J Card Surg 12:210-4.nD'Ancona G, Karamanoukian HL, Salerno TA, Schmid S, Bergsland J. 1999. Flow measurement in coronary surgery. Heart Surg Forum 2:121-4.nFonger JD, Doty JR, Salazar JD, Walinsky PL, Salomon NW. 1999. Initial experience with MIDCAB grafting using the gastroepiploic artery. Ann Thorac Surg 68:431-6.nLajos TZ. 2001. Off-pump reoperations using the right gastroepiploic artery. In: Salerno, Tomas; Ricci, Marco; Bergsland, Jacob; Karamanoukian, Hratch, editors. Beating heart coronary artery surgery. New York: Furtura Publishing Company. p 143.nNakao T, Kawaue Y. 1993. Effect of coronary revascularization with the right gastroepiploic artery. J Thorac Cardiovasc Surg 106:149-53.nOchi M, Hatori N, Fujii M, Saji Y, Tanaka S, Honma H. 2001. Limited flow capacity of the right gastroepiploic artery graft: postoperative echocardiographic and angiographic evaluation. Ann Thorac Surg 71:1210-4.nOchi M, Bessho R, Saji Y, Fujii M, Hatori N, Tanaka S. 2001. Sequential grafting of the right gastroepiploic artery in coronary artery bypass surgery. Ann Thorac Surg 71:1205-9.nPym J, Brown PM, Charette EJP, et al. 1987. Gastroepiploic coronary anastomosis. A viable alternative bypass graft. J Thorac Cardiovasc Surg 94:256-9.nRobicsek F, Svenson R, Hickllin H. 1993. Does competing flow decrease the efficiency of internal mammary grafts [letter]? J Card Surg 8:435-6.nSuma H, Fukumoto H, Takeuchi A. 1987. Coronary artery bypass grafting by utilizing in situ right gastroepilpoic artery. Basic study and clinical application. Ann Thorac Surg 44:394-7.nSuma H, Isomura T, Horii T, Sato T. 2000. Late angiographic result of using the right gastroepiploic artery as a graft. J Thorac Cardiovasc Surg 120:496-8.nTavilla G, Jackimovicz J, Berreklouw E. 1997. Intraoperative blood flow measurement of the right gastroepiploic artery using pulsed doppler echocardiography. Ann Thorac Surg 64:426-31.nVoutilainen S, Verkkala S, Jarvinen A, et al. 1998. Minimally invasive coronary artery bypass grafting using the right gastroepiploic artery. Ann Thorac Surg 65:444-8.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).