TECHNICAL ASPECTS AND LATE FUNCTIONAL RESULTS OF GASTROEPIPLOIC BYPASS-GRAFTING (400 CASES)

From January 1990 to February 1994, 400 patients (mean age 59 +/- 9 ye ars) underwent myocardial revascularization using the right gastroepip loic artery (GEA) to bypass the right coronary artery trunk or branche s. They represented 40% of all patients undergoing isolated coronary s urgery during the same period, from 19% in 1990 to 54% in 1994. Left v entricular function was normal in 32% of patients, moderately impaired in 62% and severely impaired in 6%. The GEA was used alone in six pat ients, associated with one internal mammary artery (IMA) in 111 patien ts (two arterial grafts, 2.2+/-0.4 anastomoses) and with both IMAs in 283 patients (three arterial grafts, 3.4 +/- 0.6 anastomoses); no vein graft was used. The rate of complete myocardial revascularization was 79%. Early mortality was 1.7% and influenced by left ventricular ejec tion fraction (P < 0.05). Complications occurred in 37 patients: myoca rdial infarction 4%, intra-aortic balloon pump 0.5%, reoperation for b leeding 0.5%, mediastinitis 0.25%. Early (15th postoperative day) angi ographic control of the GEA graft was performed in 104 patients operat ed from January 1990 to December 1991 and the patency rate was 92%; an omalies of GEA were three occlusions, five stenoses, three competitive flow, no string or slender sign. Early functional results (3 +/- 1 mo nths postoperatively) were studied in 192 patients during exercise tes t with medical treatment: 99% were symptom-free and 14% had electrocar diographic (EGG) ischemic modification significantly correlated with i ncomplete revascularization (P<0.01). The 2- and 4-year actuarial surv ival rate was 96.7 +/- 1.9%. The rate of late cardiac events was 2% pa tient/year; Angioplasty for GEA graft failure was required in four pat ients. A 2-year postoperative functional assessment without medical tr eatment was performed during exercise test in 66 patients who had rece ived three arterial grafts: 98% were symptom-free and 26% had ECG isch emic modification significantly correlated with incomplete revasculari zation (P<0.01); during the same procedure, thallium myocardial scinti graphy was obtained in 50 patients: 18 patients (36%) had asymptomatic ischemic defects on exercise significantly correlated with incomplete revascularization and ECG ischemic changes (P<0.01). However, posteri or thallium defects demonstrated limited GEA flow at the maximum level of exercise in at least 8% of patients. Myocardial revascularization using the GEA can be achieved with minimal operative risk and offers s atisfactory functional results and midterm survival rate.