Off-Pump Total Arterial Revascularization Using the Skeletonized Right Gastroepiploic Artery as a Third Arterial Conduit; Early and Midterm Results

Lee, Hyun Joo; Choi, Jae Sung; Kim, Ki Bong

Abstract

BACKGROUND: The aim of this study was to evaluate the early and midterm results of off-pump total arterial revascularization using the skeletonized right gastroepiploic artery (RGEA) as a third arterial conduit. MATERIAL AND METHOD: We prospectively analyzed 103 patients who underwent off-pump total arterial revascularization using bilateral internal thoracic arteries (ITAs) and RGEA. The RGEA was used as in situ graft in 88 patients, composite graft in 10 patients, and free graft in 5 patients. Postoperative coronary angiographies were performed before discharge in 100 patients, and at postoperative one year in 88 patients. RESULT: The RGEA showed a significantly higher free flow (130+/-95 ml/min) than that of right ITA (113+/-57 ml/min) or left ITA (107+/-55 ml/min), which was measured before anastomosis (p<0.05). The total number of distal anastomoses was 3.8+/-0.7. The number of distal anastomoses per bilateral ITAs was 2.8+/-0.7 and the number of distal anastomosis per RGEA was 1.0. There were two mortalities including one operative mortality. The late mortality was not related to cardiac events. Early postoperative morbidities were atrial fibrillation in 15 patients, bleeding reoperation in 4 patients, mediastinitis in 1 patients, perioperative myocardial infarction in 2 patient, and transient ARF in 3 patients. Postoperative coronary angiographies showed the early patency rate of 98.6% (272/276) for ITAs and 97.0% (97/100) for RGEA, respectively (p=ns), and the one-year patency rate of 95.9% (234/244) for ITAs and 88.6% (78/88) for RGEA, respectively (p=0.07). Flow competition between the RGEA and NCA (native coronary artery) was seen in 5 of the 100 patients (5.0%) immediate postoperatively and 7 of the 88 patients (8.0%) 1 year after surgery. Since July, 2000, we measured transit time flow intraoperatively and could reduce flow competition significantly.
CONCLUSION
The skeletonized RGEA demonstrated excellent early and midterm patency rates and could be used as a third arterial graft following the bilateral ITAs.