CLINICAL-EXPERIENCE WITH THE RIGHT GASTROEPIPLOIC ARTERY IN CORONARY-ARTERY BYPASS-GRAFTING

The excellent long-term results with the internal mammary artery for c oronary artery bypass grafting have prompted the search for other cond uits with similar characteristics. From December 1989 to December 1991 , the right gastroepiploic artery (RGEA) has been used as an in situ g raft to the posterior descending coronary artery in 51 patients at the Montreal Heart Institute. The patients' age averaged 50 +/- 11 years. Three-vessel coronary artery disease was present in 41 patients and t wo-vessel disease in the remaining 10 patients. In all but 1 patient, bilateral internal mammary artery grafting was performed in addition t o RGEA grafting. The number of grafts per patient averaged 3.2 +/- 0.8 . There was no operative mortality. Morbidity was minimal with only my ocardial infarction and a pleural effusion in 1 patient. In 1 patient, a splenectomy had to be performed because of iatrogenic tear during d issection of the RGEA. The average hospital stay was 8.2 +/- 2.6 days. Enteral nutrition was resumed on average 2 days after operation. Angi ographic evaluation of RGEA grafts was performed before discharge or w ithin the first month after surgery in 31 patients. In 28 patients (28 /31, 90%) the RGEA graft was patent, two grafts were occluded, and in the remaining patient, the graft could not be visualized due to techni cal difficulties during angiography. A second angiographic evaluation was performed in 5 patients, 1 year after operation. Four RGEAs were p atent and 1 was occluded. Clinical follow-up averaged 4 months (range 1 to 15 months). Forty-six of the patients were in NYHA class I. There fore, coronary artery bypass grafting with the RGEA may be a useful al ternative or adjunct in selected patients. It is associated with a low morbidity, and it does not prolong hospital stay. A longer follow-up evaluation and more angiographic assessments of these grafts are neede d to determine the long-term value of this conduit in coronary artery bypass grafting.