title: Gastroepiploic artery minimally invasive grafting in reoperative patients with patent mammaries.
abstract: BACKGROUND
  Patients with patent grafted bilateral internal thoracic arteries may require repeat myocardial revascularization because of either progression of disease in a nongrafted native vessel or failure of a saphenous vein graft. In order to avoid extensive dissection and possible damage of the internal thoracic arteries, we elected to proceed with an off-pump minimally invasive direct coronary artery bypass grafting (MIDCABG) approach using the pedicled right gastroepiploic artery. This paper summarizes our midterm angiographic results.
  
  
  METHODS
  From 1996 to 2003, 15 patients were reoperated on using this approach in our department. Internal thoracic artery grafts always revascularized the anterior and lateral territories and were angiographically patent. Indications for repeated surgery were: (1) coronary disease progression in 8 patients; (2) occlusion of the saphenous vein graft in 6 patients; and (3) anastomotic stenosis of a pedicled right gastroepiploic artery in 1 patient. Off-pump grafting of the pedicled right gastroepiploic artery was targeted at the posterior descending artery in 14 patients, and at the left anterior descending artery in 1 patient.
  
  
  RESULTS
  Thirty-day mortality was 6.5% (1 of 15 patients). With a mean follow-up of 56 +/- 20 months, angina-free survival was 79%. At angiographic control (mean, 38 months), the pedicled right gastroepiploic artery was patent in 13 patients. One patient had an occluded right gastroepiploic artery graft at 23 months and another patient showed progression of disease distal to the right gastroepiploic artery anastomosis at 28 months.
  
  
  CONCLUSIONS
  Off-pump MIDCABG repeat revascularization with a pedicled right gastroepiploic artery is an effective method of revascularization for patients with patent bilateral internal thoracic arteries.
authors.affiliation: Department of Cardiovascular Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. dglineur@hotmail.com
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Alain
authors.initials: A
authors.lastname: Poncelet
authors.forename: Claude
authors.initials: C
authors.lastname: Hanet
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Robert
authors.initials: R
authors.lastname: Verhelst
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Etienne
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D001940:Breast / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery; D018450:Disease Progression; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery / Q000601:surgery*; D006801:Humans; D008323:Mammary Arteries / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014654:Vascular Patency