INTRAOPERATIVE BLOOD-FLOW MEASUREMENT OF THE RIGHT GASTROEPIPLOIC ARTERY USING PULSED DOPPLER-ECHOCARDIOGRAPHY

Background. In coronary artery revascularization, the right gastroepip loic artery (GEA) has become the third arterial conduit of choice afte r both internal thoracic arteries. To evaluate the function of the rig ht GEA, we used intraoperative ultrasonographic Doppler measurement of the blood flow of this artery. Methods. From November 1992 to Decembe r 1993, in 41 consecutive patients, graft flow velocity, diameter, and blood flow were measured in the proximal part of the GEA before taked own and after completion of the anastomosis just before sternal closur e. We also analyzed the predictors of postoperative ischemia. Results. Flow volume of the GEA after anastomosis with the coronary artery has a significant correlation with the diameter of the target coronary ar tery (p = 0.0011). Two patients had development of ischemia postoperat ively. In both, volume flow of the GEA was less than 25 mL/min before takedown compared with an average flow of 55.78 mL/min in the patients without ischemia postoperatively. This was found to be a prognostic i ndicator of poor graft performance with consequent ischemia. Conclusio ns. When the GEA blood flow volume before takedown is less than 25 mi/ min, we suggest that this artery not be used as a bypass graft for myo cardial revascularization. (C) 1997 by The Society of Thoracic Surgeon s.