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Ann Thorac Surg 2001;72:2184-2185
© 2001 The Society of Thoracic Surgeons

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Correspondence

Right gastroepiploic artery for coronary artery bypass grafting: a word of caution: Reply

^a Department of Cardiac Surgery, Okazaki City Hospital, Kohryuji-chou, Okazaki City, Aichi 444-8553 Japan
^b Division of Cardiovascular Surgery, Cardiovascular Center, Aichi Prefectural Owari Hospital, Kariyasuga, Ichinomiya City, Aichi 491-0934 Japan

To the Editor

We thank Dr Chavanon and his colleagues for their insightful comments concerning our recent article, and we congratulate them on their excellent clinical work. Our study undoubtedly has demonstrated that an in situ arterial graft such as the internal mammary artery (IMA) and the right gastroepiploic artery (GEA) may have a potential risk of limited flow. Particularly, the physiological adaptability of the GEA has not yet been demonstrated in comparison with the IMA. Therefore, if the flow through the proximal segment of the target coronary artery is overwhelmingly dominant over that of the GEA, GEA graft failure or occlusion may occur. Since the introduction of in situ arterial grafts, little investigation has been done concerning strict indications. In clinical practice, many cardiac surgeons may decide to use or discard in situ arterial grafts according to free flow measurements. However, measurement of free flow just before anastomosis is unreliable because of spasm or mechanical damage during harvesting. Instead of free flow measurements some reports emphasize that an in situ arterial graft should be at least equal in size to a grafted artery [1].

With respect to criteria for the use of arterial grafts, our study supports an empiric concept that the size of an in situ arterial graft should be larger than that of the recipient vessel in selection for a bypass graft [2]. To avoid unfavorable angiographic findings, which show overwhelmingly dominant flow through the proximal segment of a native coronary artery postoperatively, preoperative measurement of the diameters in both vessels, in addition to the accurate evaluation of the proximal stenosis, is important. Theoretical analysis from calculations based on Poiseuille’s law agrees closely with clinical findings.

To use the GEA as a second reliable graft, we recently developed a new technique termed "transplantation of the en bloc omentum system for coronary revascularization" [3]. This technique allows a surgeon to use a GEA with a larger diameter and a shorter length to improve long-term patency.

References

1. Geha A.S. Crossed double internal mammary-to-coronary artery grafts. Arch Surg 1976;111:289-292.[Abstract/Free Full Text]
2. Green G.E. Technique of internal mammary-coronary artery anastomosis. J Thorac Cardiovasc Surg 1979;78:455-461.[Medline]
3. Matsuura A., Yasuura K., Yoshida K., et al. Transplantation of the en bloc vascular system for coronary revascularization. J Thorac Cardiovasc Surg 2001;121:520-525.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kenzo Yasuura Hiroshi Okamoto Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yasuura, K. Articles by Matsuura, A. Search for Related Content PubMed Articles by Yasuura, K. Articles by Matsuura, A. Related Collections Coronary disease Related Article