The Right Gastroepiploic Artery for CABG
Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan.
OBJECTIVE:One of the optimal strategies for CABG in patients with multi-vessel disease maybe total arterial grafting. To perform total arterial revascularization, the benefits of bilateral internal thoracic artery (ITA) grafting has been well documented. However, it has not been proved what is the third best arterial graft, radial artery (RA) or right gastroepiploic artery (GEA). In western countries, the RA is more popular to be used than the GEA, which is popular to be used in Japan. The first successful GEA grafting was performed by Dr. Suma on 1986. There are several concerns regarding the use of the GEA for CABG. The main concern can be spasm and flow competition. Long-term result is another concern.To avoid these concerns, the GEA should be used as an in situ graft, target vessel should be distal RCA, stenosis of the target vessel should be exceeded 90%, and the GEA should be harvested in a skeletonized fashion.
METHODS:Since the opening of my center in 2007 to December 2016, 1333 patients performed OPCAB, which was about 97% of all isolated CABG cases. The GEA was used in half of patients. Bilateral ITA was also used in half of patients. Two groups who received the GEA to RCA and the SVG to RCA were compared.
Of the 938 patients who received a graft to the RCA, 502 were grafted with the GEA and 414 with the SVG. Hospital mortality was the same for both groups as was major morbidity. However, the GEA had better survival out to 7 years.
The GEA can be the "third" best arterial conduit for CABG.
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