Right Gastroepiploic Artery for Revascularization of the Right Coronary Territory in Off-Pump Total Arterial Revascularization: Strategies to Improve Patency

Abstract

We evaluated the early and 1-year postoperative results of grafting the skeletonized right gastroepiploic artery to the right coronary territories. One hundred and seventy-five patients who underwent off-pump total arterial revascularization using the skeletonized right gastroepiploic artery and bilateral internal thoracic arteries were studied. The right gastroepiploic artery was used for revascularizing the right coronary territories, and bilateral internal thoracic arteries were used for revascularizing the left coronary territories. We revised the in-situ right gastroepiploic artery graft into a composite or free graft if the flowmeter measurement suggested a competitive flow pattern. Postoperative angiographies were performed in 98.3% of the patients before discharge, and in 92.0% of the patients 1 year after surgery. Hospital mortality was 0.6%. Postoperative angiography showed early patency rate of 98.3% for the right gastroepiploic artery and 99.4% for the internal thoracic artery (p = 0.352), and 1-year patency rate of 92.0% for the right gastroepiploic artery and 97.2% for the internal thoracic artery (p = 0.009). Flow competition of the right gastroepiploic artery was observed in 5.2% of the patients at the early postoperative angiography and in 6.8% of the patients 1 year after surgery. The incidence of right gastroepiploic artery graft flow competition was significantly decreased compared with that of the pre-flowmeter period (p = 0.036 at early angiography; p = 0.017 at 1-year angiography). The skeletonized right gastroepiploic artery grafted to the right coronary territory demonstrated excellent early and 1-year patency rates. Flow competition of the in situ right gastroepiploic artery may be overcome by intraoperative revision of graft based on flow measurement.