GASTROEPIPLOIC AND INFERIOR EPIGASTRIC ARTERIES FOR CORONARY-ARTERY BYPASS - EARLY RESULTS AND EVOLVING APPLICATIONS

Background Internal thoracic artery (ITA) conduits are known to provid e long-term patency and increased patient survival with low morbidity after coronary artery bypass grafting (CABG). Excellent clinical resul ts with the ITA have stimulated interest in additional arterial grafts . Methods and Results To review our experience and evaluate postoperat ive complications associated with these new conduits, from May 1985 to September 1993, we studied 290 patients who underwent CABG using addi tional arterial conduits. The right gastroepiploic artery (GEA) was us ed in 152 patients and the inferior epigastric artery (IEA) was used i n 130 patients. Eight patients with both GEA and IEA grafts were exclu ded. Patient records were analyzed as to preoperative characteristics, angiographic findings, operative data, and postoperative complication s. Statistical analysis was done using the Pearson chi(2) statistic an d the t test. Ninety-eight percent of patients received one concomitan t ITA graft, and the majority of patients in both groups had bilateral ITA grafts. The GEA group had a higher proportion of reoperations (GE A group, 54%; IEA group, 16%; P<.001), previous myocardial infarction (MI) (GEA group, 67%; IEA group, 50%; P=.004) and New York Heart Assoc iation class IV (GEA group, 28%; IEA group, 6%; P=.001). The IEA group was generally slightly older (IEA group, 56 years; GEA group, 52 year s; P=.001). Hospital mortality (GEA group, 4%; IEA group, 0.8%) and po stoperative morbidity (mediastinal bleeding, infection, stroke, MI, an d low cardiac output) were not significantly different between the two groups or from our experience with routine CABG using the ITA. Three intraabdominal complications occurred in the GEA group: 2 episodes of bleeding and 1 of pancreatitis. One patient in the IEA group had abdom inal wall bleeding. With overall short followup, angiographic patency in a small number of patients has been good: 80% for the GEA group and 85.7% for the IEA group. Conclusions We conclude that the morbidity a ssociated with these additional arterial conduits is low and is compar able with that associated with routine CABG using the ITA. Currently w e use the ITA for primary targets and alternative arterial conduits fo r vessels of secondary importance or when the ITA and/or saphenous vei n is not available.