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Ann Thorac Surg 2007;83:1024-1029
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Gastroepiploic Artery Grafting Does Not Improve the Late Outcome in Patients With Bilateral Internal Thoracic Artery Grafting

Jiro Esaki, MDa,*, Takaaki Koshiji, MDa, Minoru Okamoto, MDa, Masaki Tsukashita, MDa, Takeshi Ikuno, MDa, Ryuzo Sakata, MDb

a Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto
b Department of Thoracic and Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

Accepted for publication October 6, 2006.

* Address correspondence to Dr Esaki, Department of Cardiovascular Surgery, Kumamoto Central Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965, Japan (Email: j_esaki{at}yahoo.co.jp).

Background: Bilateral internal thoracic artery grafting in coronary artery bypass surgery has a better long-term outcome than single internal thoracic artery grafting. However, the efficacy of gastroepiploic artery (GEA) grafting in addition to bilateral internal thoracic artery grafting is still not well-established.

Methods: From 1989 to 1999, 311 patients underwent coronary artery bypass grafting using in situ bilateral internal thoracic arteries anastomosed to the left coronary arteries and either an in situ GEA or a saphenous vein graft (SVG) anastomosed to the right coronary artery. Ninety-nine patients using the in situ GEA (GEA group) were compared with 212 patients using the SVG (SVG group) anastomsed to the right coronary artery. Young patients and patients with hyperlipidemia were more prevalent in the GEA group.

Results: The seven-year survival rate in the GEA group and the SVG group were 94.7% and 87.2%, respectively (p = 0.068). In a multivariate analysis, the age, renal failure, and a low ejection fraction (<0.40) were all significant predictors of survival. The GEA was not a significant predictor. The seven-year freedom rates from cardiac events were similar in both groups (GEA group, 76.5%; SVG group, 78.6%; p = 0.455). The seven-year freedom rates from recurrent angina were also similar between the groups (GEA group, 85.3%; SVG group, 88.8%; p = 0.700).

Conclusions: In comparison with SVG grafting, GEA grafting to the right coronary artery did not significantly improve the late outcomes in patients with bilateral internal thoracic artery grafting.


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Invited commentary
Alfred J. Tector
Ann. Thorac. Surg. 2007 83: 1029. [Extract] [Full Text] [PDF]



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A. J. Tector
Invited commentary
Ann. Thorac. Surg., March 1, 2007; 83(3): 1029 - 1029.
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