Intraoperative flow measurements in gastroepiploic grafts using pulsed Doppler

Objective: The patency of a pedicled right gastroepiploic artery (RGEA) gra ft can be compromised by intraoperative twists, kinks or spasms. Therefore, a systematic flow assessment was made in RGEA grafts and was compared with similar measurements made in other types of bypass conduits, Methods: Intr aoperative pulsed Doppler flowmeter measurements obtained in a series of 55 6 consecutive patients undergoing at least one coronary bypass grafting ont o the right coronary system were studied. Eighty-five RGEA grafts were comp ared with 1427 bypass grafts implanted in the same group of patients and co nsisted of the following conduits: 442 left internal mammary (LIMA), 149 ri ght internal mammary (RIMA), 831 greater saphenous vein (GSV) and five infe rior epigastric (EPIG) grafts. Sequential grafts were excluded from the ana lysis. Results: Flow measurements and Doppler waveforms were abnormal and r equired graft repositioning, and the addition of a distal graft or intragra ft papaverine injection (only in GSVs) in 29 cases (2.0% of all grafts). Th ese graft corrections were necessary in 5.9% RGEAs, 3.4% LIMAs, 2.0% RIMAs, and 0.7% GSVs (P < 0.001). The relative risk for graft correction was eigh t times higher for RGEAs than for GSVs (P = 0.002). Flow increased from 8 /- 2 to 54 +/- 5 ml/min (P < 0.0001). Row data were significantly influence d by the type of run-off bed (P < 0.001), the measurements obtained in graf ts implanted onto the right coronary artery and the left anterior descendin g artery being superior. Flows in RGEAs, however, were comparable with valu es obtained in other grafts implanted onto the same recipient coronary arte ry. Conclusions: A significantly higher incidence of graft malpositioning c aused inadequate flows in RGEAs. However, normal flow values could be resto red simply by assigning a better graft orientation under pulsed Doppler flo wmeter control. Overall flow capacity of the RGEA did not differ from value s obtained in other arterial and venous grafts implanted onto the same reci pient arteries. (C) 1999 Elsevier Science B.V. All rights reserved,