EXCLUSIVE USE OF ARTERIAL GRAFTS IN CORONARY-ARTERY BYPASS OPERATIONSFOR 3-VESSEL DISEASE - USE OF BOTH THORACIC ARTERIES AND THE GASTROEPIPLOIC ARTERY IN 256 CONSECUTIVE PATIENTS

Methods: From September 1989 to September 1994 we operated on a consec utive group of 256 patients with three-vessel disease in whom we used the right gastroepiploic artery together with both internal thoracic a rteries, Vein grafts were not used in these patients, This population consisted of 233 men and 23 women whose ages ranged from 31 to 77 year s (mean age 57.8 years), Results: Hospital morbidity and mortality wer e not directly related to the use of the gastroepiploic artery, Patenc y of the anastomoses in a subgroup of 56 patients (22%) a mean of 16 m onths after the operation was 98% for the left internal thoracic arter y, 96% for the right internal thoracic artery, and 88% for the gastroe piploic artery, Five-year actuarial survival (including in-hospital de aths) was 95.9% and was related only to age, From discharge until the end of follow-up, two patients had a myocardial infarction, six patien ts underwent a reintervention procedure, and 18 patients had a return of angina pectoris, Conclusion: We conclude that the concomitant use o f the gastroepiploic artery with the both internal thoracic arteries h as low morbidity and mortality in patients with three-vessel disease o perated on by experienced surgeons, At this moment, we have no reason to believe graft patency will deteriorate in the future, On the basis of these results, the knowledge that arteries are to be preferred over veins for coronary bypass grafting, and the absence of a leg incision , we believe this operative technique is superior to the use of venous grafts.