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Ann Thorac Surg 1999;68:431-436
© 1999 The Society of Thoracic Surgeons

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Original Articles

Initial experience with MIDCAB grafting using the gastroepiploic artery

^a Divisions of Division of Cardiac Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
^b Division of Cardiac Surgery,Washington Adventist Hospital, Takoma Park, Maryland, USA

Address reprint requests to Dr Fonger, Adventist Heart, Washington Adventist Hospital, 7610 Carroll Ave, Suite 440, Takoma Park, MD 20912
e-mail: jfonger{at}heartnet.org

Background. Minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery can be used in primary operations and reoperations to revascularize the inferior or anterior surface of the heart.

Methods. Patients who had symptomatic coronary artery disease limited to a single coronary distribution were selected. Coronary targets were grafted with the pedicled gastroepiploic artery through a small midline epigastric incision. Patients were followed with scheduled outpatient clinic visits, Doppler examination, and selective recatheterization.

Results. Between May 1995 and November 1997, 74 patients underwent gastroepiploic artery minimally invasive direct coronary artery bypass grafting; 33 (45%) had a primary operation and 41 (55%), a reoperation. Grafting was performed to the distal right coronary artery (n = 38), the posterior descending artery (n = 28), or the distal left anterior descendng coronary artery (n = 8). There were six deaths (8%) within 30 days after operation. Twenty patients (28%) underwent recatheterization; there were two graft occlusions, two graft stenoses, and five anastomotic stenoses. Of 60 patients seen 2 or more weeks after operation, 53 (88%) had resolution of anginal symptoms at a mean follow-up of 10.9 months (range, 0 to 30 months).

Conclusions. Inferior minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery avoids the risks of repeat sternotomy, aortic manipulation, and cardiopulmonary bypass. Patency rates, however, were lower than expected, and there is significant morbidity and mortality associated with high-risk patients undergoing the procedure. Continued follow-up is essential to evaluate long-term graft patency and patient survival.

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