Objective: To improve the longterm outcome following CABG, several strategies have been employed using arterial conduits. Our 20 years experience with the right gastroepiploic artery (GEA) graft was evaluated.
Methods: Since 1986, GEA has been used for coronary artery bypass grafting (CABG) in 1400 patients. There were 1139 males and 261 females with a mean age of 63 years. Single-, double-, and triple-vessel and left main disease were noted in 9, 216, 933 and 2542 patients, respectively. Internal thoracic artery (ITA) saphenous vein and radial artery grafts were concomitantly used in 1362(97%), 793(57%) and 139(10%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites of GEA grafting were 70 anterior descending, 7 diagonal, 288 circumflex, and 1119 right coronary arteries.
Results: Operative mortality was 1.2% (17patients). In 971 patients who were completed follow up, 5, 10 and 15 year survival rates were 90.6%, 80.8% and 71.1%, and the cardiac death-free survival rates were 95.3%, 91.9% and 88.7%, respectively. Postoperative angiography revealed 95% (996/1049) early (within 1year), 87% (152/174) midterm (1-5years) and 85% (51/60) late (5-15 years) patency rates of the GEA grafts. Risk factors for late occlusion were anastomotic stenosis and less critical stenosis in the grafted coronary artery. A skeltonized GEA graft was preferentially used in the last 5 years in 247 patients. Postoperative angiography was perfomed in 223 skeltonized GEA grafts with 273 distal anastomoses, and the patency rate was 97% (7 occluded) within 1 postoperative year and 87% at 4 postoperative years.
Conclusions: GEA is a safe and effective arterial conduit for CABG. Skeltonized GEA is beneficial with a wider use of composite sequential grafting.