Does use of gastroepiploic artery graft increase surgical risk?

Abstract

Seventy patients in whom the gastroepiploic artery was used for coronary artery bypass grafting were compared with 70 patients in whom the gastroepiploic artery was not used. Mean age was 56.8 years in the group in which this artery was used and 61.8 years in the group in which it was not (p less than 0.001). All other preoperative characteristics including number of women, extent of coronary artery disease, previous myocardial infarction, unstable angina, and preoperative left ventricular function were not significantly different between the two groups. An internal mammary artery graft was concomitantly used in 68 patients (97%) of the group with a gastroepiploic artery graft and in 61 patients (87%) without such a graft. The mean number of distal anastomoses was 3.3 and 3.4, aortic crossclamp time was 65.3 +/- 19.9 minutes and 54.0 +/- 20.1 minutes, and cardiopulmonary bypass time was 114.8 +/- 23.6 minutes and 112.9 +/- 25.0 minutes, respectively, in the groups with and without a gastroepiploic artery graft. Only aortic crossclamp time was significantly (p less than 0.05) longer in the group with a gastroepiploic artery graft. There were two (2.9%) early deaths and two (2.9%) new Q-wave infarctions in both groups. Intraaortic balloon pumping was required in five patients (7.1%) in the group with a gastroepiploic artery graft and in three patients (4.3%) without this graft. Postoperative complications were similar and rare in both groups. Intraoperative endoscopic laser Doppler study demonstrated no significant change of gastric mucosal blood flow before and after division of the gastroepiploic artery. We concluded that there is no additional risk in the use of the gastroepiploic artery for coronary bypass grafting, and a favorable outcome can be expected.