Minimally invasive coronary artery bypass grafting using the right gastroepiploic artery without pump.
OBJECTIVE
To explore the feasibility to operate on the right coronary artery and its branches utilizing the right gastroepiploic artery (RGEA) without cardiopulmonary bypass (CPB). All cases were performed since May 1996.


METHODS
A small mid-line incision including splitting of the lower sternum gave excellent exposure. The inferior surface of the heart was dissected to expose and stabilize the target vessel. The heart rate was controlled with a Diltiazem drip. CPB was not necessary in any case. The right coronary artery was bypassed in four patients, the posterior descending artery branch in five patients and the terminal circumflex of the left coronary artery in one patient. After grafting, patency of the anastomosis was demonstrated by Doppler echocardiogram.


RESULTS
No patient had perioperative mortality or complications. No patient had recurrent angina. Color Doppler echocardiographic imaging studies before discharge confirmed patency of the graft in eight of ten cases. In two cases, the gastroepiploic artery could not be visualized. Angiographic visualization was positive in four out of five cases.


CONCLUSIONS
The gastroepiploic artery is an excellent conduit for vascularization of the inferior aspect of the heart. The operation can be done using a minimally invasive technique and without the use of cardiopulmonary bypass. This approach seems especially applicable in selective reoperative cases.
Akhter
M
M
State University of New York at Buffalo and The Buffalo General Hospital Division of Cardiac Surgery, USA.
Lajos
T Z
TZ
Grosner
G
G
Bergsland
J
J
Visco
J
J
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009852:Omentum / Q000098:blood supply; D012086:Reoperation; D013270:Stomach / Q000098:blood supply