REOPERATIONS WITH THE RIGHT GASTROEPIPLOIC ARTERY WITHOUT CARDIOPULMONARY BYPASS

The right gastroepiploic artery (RGEA) has been utilized as the bypass conduit on the inferior surface of the heart with a minimally invasiv e approach. Fourteen patients had reoperative coronary bypass surgery for severely symptomatic single-vessel disease of the right coronary a rtery. All surgeries were performed since May 1996. A small mid-line i ncision including splitting of the lower sternum gave excellent exposu re. The inferior surface of the heart was dissected to expose and stab ilize the target vessel. The heart rate was controlled with a diltiaze m drip. Cardiopulmonary bypass was not necessary in any case. The righ t coronary artery was bypassed in three patients, the posterior descen ding artery branch in ten patients, and the terminal circumflex of the left coronary artery in one. After grafting, patency of the anastomos is was demonstrated by Doppler echocardiogram, Two patients had left a nterior descending artery (LAD) grafts with LIMA (left mammary artery) and RGEA grafts performed simultaneously with two port access incisio ns. No patient had perioperative mortality or complications. No patien t had recurrent angina. Doppler color echocardiographic imaging studie s before discharge confirmed patency of the graft in 13 of 14 cases. I n one case, the gastroepiploic artery could not be visualized. Angiogr aphic visualization was positive in seven cases; seven patients were n ot studied yet. The gastroepiploic artery is an excellent conduit for vascularization of the inferior aspect of the heart. The operation can be done with a minimally invasive technique and without the use of ca rdiopulmonary bypass. This approach seems especially applicable in sel ective reoperative cases.