MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING USING THE RIGHT GASTROEPIPLOIC ARTERY

Background. Anastomosis of the left internal thoracic artery to the le ft anterior descending artery without sternotomy and without cardiopul monary bypass is a standard approach in minimally invasive coronary ar tery bypass grafting. To expand the indications for minimally invasive coronary artery bypass grafting from one-vessel disease to two-vessel disease, we began to perform anastomosis of the right gastroepiploic artery (RGEA) to the right coronary artery (RCA). Methods. From Februa ry to November 1996, an RGEA graft was used in 25 of the 100 patients who underwent minimally invasive coronary artery bypass grafting at ou r clinic. Eleven of the patients had only RCA disease and 14 had both RCA and left anterior descending artery disease. One of the operations was a redo coronary artery bypass grafting. The RGEA was anastomosed to the RCA through a laparotomy incision and the left internal thoraci c artery was anastomosed to the left anterior descending artery throug h a left anterior thoracotomy. In 5 patients, the RGEA was lengthened by venous grafting. Results. All patients underwent angiography after operation; 82.6% of the RGEA grafts and all the left internal thoracic artery grafts were functioning well. In three of the four nonvisualiz ed RGEA grafts, the percentage of proximal stenosis of the RCA seen on postoperative angiography was not critical (40%, 50%, and 50%, respec tively), allowing significant competitive flow through the native bypa ssed RCA. The patency of all the RGEA grafts without competitive now w as 95%, with a 95% confidence interval of 75.1% to 99.9%. Conclusions. The indications for minimally invasive coronary artery bypass graftin g could be extended to primary operations in patients with left anteri or descending artery and RCA lesions by using both the left internal t horacic artery and the RGEA. (C) 1998 by The Society of Thoracic Surge ons.