Evaluation of the Potential of Retrograde Flow Competition in the Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting

Chung, Bong Kyu; Sun, Kyung; Kwon, Joon; Kim, Kwang Ho; Jung, Jae Seung; Son, Ho Sung; Lee, Sung Ho; Kim, Kwang Taik; Kim, Hyoung Mook

Abstract

BACKGROUND: Due to the concern of flow competition or retrograde steal, it has been generally suggested that the right gastroepiploic artery(RGEA) pedicled graft should be used in critical coronary stenosis lesion. The study was designed to evaluate the potential of retrograde flow competition in the RGEA pedicled graft by measuring the native pressure differences(PD) between the normal coronary artery and celiac arterial pressure, which would be compared with trans-stenosis pressure gradients(TSPG) in coronary artery occlusive disease. MATERIAL AND METHOD: Between July, 1998 and February, 1999, pressures of the right coronary artery and the right gastroepiploic artery(or the celiac artery) were measured in patients with the patent right coronary artery(n=12). The PD between the arteries was compared with the TSPG in the occlusive coronary arteries(n=32). RESULT: The pressures of the normal right coronary artery and celiac artery were 143+/-23 vs. 134+/-17mmHg in systole(p<0.005), 74+/-13 vs. 73+/-14mmHg in diastole(p=NS), and 100+/-16 vs. 97+/-15mmHg in mean (p0.05). The PD between the arteries were -8~25mmHg in systole, -4~7 mmHg in diastole, and -1~10mmHg in mean. The TSPG measured in the occlusive coronary arteries were -4~19(7+/-5.8)mmHg in the lesion less than 75% stenosis vs. 7~74(27+/-18.3)mmHg in the 75% or over stenosis lesion(p0.005). The normally existing pressure difference between the coronary arteries and RGEA(15~20mmHg) was significantly less than the TSPG in the occlusive coronary artery with 75% or over stenosis(p0.001).
CONCLUSION
If the pressure gradient between the RGEA and the coronary artery distal to the stenosis is the main determinant of development of retrograde flow competiton in the RGEA pedicled graft, the above data suggests that there will be little chance of competition when it is used in the coronary lesion with 75% or over stenosis.