Gastroepiploic and inferior epigastric arteries for coronary artery bypass. Early results and evolving applications

Abstract

Background: Internal thoracic artery (ITA) conduits are known to provide long-term patency and increased patient survival with low morbidity after coronary artery bypass grafting (CABG). Excellent clinical results with the ITA have stimulated interest in additional arterial grafts.

Methods and results: To review our experience and evaluate postoperative complications associated with these new conduits, from May 1985 to September 1993, we studied 290 patients who underwent CABG using additional arterial conduits. The right gastroepiploic artery (GEA) was used in 152 patients and the inferior epigastric artery (IEA) was used in 130 patients. Eight patients with both GEA and IEA grafts were excluded. Patient records were analyzed as to preoperative characteristics, angiographic findings, operative data, and postoperative complications. Statistical analysis was done using the Pearson chi 2 statistic and the t test. Ninety-eight percent of patients received one concomitant ITA graft, and the majority of patients in both groups had bilateral ITA grafts. The GEA group had a higher proportion of reoperations (GEA group, 54%; IEA group, 16%; P < .001), previous myocardial infarction (MI) (GEA group, 67%; IEA group, 50%; P = .004) and New York Heart Association class IV (GEA group, 28%; IEA group, 6%; P = .001). The IEA group was generally slightly older (IEA group, 56 years; GEA group, 52 years; P = .001). Hospital mortality (GEA group, 4%; IEA group, 0.8%) and postoperative morbidity (mediastinal bleeding, infection, stroke, MI, and low cardiac output) were not significantly different between the two groups or from our experience with routine CABG using the ITA. Three intraabdominal complications occurred in the GEA group: 2 episodes of bleeding and 1 of pancreatitis. One patient in the IEA group had abdominal wall bleeding. With overall short follow-up, angiographic patency in a small number of patients has been good: 80% for the GEA group and 85.7% for the IEA group.

Conclusions: We conclude that the morbidity associated with these additional arterial conduits is low and is comparable with that associated with routine CABG using the ITA. Currently we use the ITA for primary targets and alternative arterial conduits for vessels of secondary importance or when the ITA and/or saphenous vein is not available.