Intraoperative blood flow measurement of the right gastroepiploic artery using pulsed Doppler echocardiography.
BACKGROUND
In coronary artery revascularization, the right gastroepiploic artery (GEA) has become the third arterial conduit of choice after both internal thoracic arteries. To evaluate the function of the right GEA, we used intraoperative ultrasonographic Doppler measurement of the blood flow of this artery.


METHODS
From November 1992 to December 1993, in 41 consecutive patients, graft flow velocity, diameter, and blood flow were measured in the proximal part of the GEA before takedown and after completion of the anastomosis just before sternal closure. We also analyzed the predictors of postoperative ischemia.


RESULTS
Flow volume of the GEA after anastomosis with the coronary artery has a significant correlation with the diameter of the target coronary artery (p = 0.0011). Two patients had development of ischemia postoperatively. In both, volume flow of the GEA was less than 25 mL/min before takedown compared with an average flow of 55.78 mL/min in the patients without ischemia postoperatively. This was found to be a prognostic indicator of poor graft performance with consequent ischemia.


CONCLUSIONS
When the GEA blood flow volume before takedown is less than 25 mL/min, we suggest that this artery not be used as a bypass graft for myocardial revascularization.
Tavilla
G
G
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Jackimovicz
J
J
Berreklouw
E
E
D000328:Adult; D000714:Anastomosis, Surgical; D001158:Arteries / Q000502:physiology / Q000637:transplantation; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass; D018619:Echocardiography, Doppler, Pulsed; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D009852:Omentum / Q000098:blood supply; D011183:Postoperative Complications; D011379:Prognosis; D013270:Stomach / Q000098:blood supply