Transit-time flow characteristics of in situ right gastroepiploic arterial grafts in coronary artery bypass grafting.
OBJECTIVE
We investigated flow characteristics of right gastroepiploic arterial grafts, widely used to extend in situ arterial conduits in coronary artery bypass grafting.


METHODS
Intraoperative transit-time measurements and postoperative angiographic findings were obtained for 111 patients undergoing coronary artery bypass grafting with gastroepiploic artery and bilateral internal thoracic arteries: mean, maximum, and minimum flows; pulsatility index; insufficiency rate; and differentiated index of early diastolic flow.


RESULTS
Favored target for gastroepiploic artery was posterior descending artery (106 patients, 95%). Patency rates were 91.0% for gastroepiploic artery, 98.2% for left internal thoracic artery, and 97.5% for right internal thoracic artery. There were four flow profiles of gastroepiploic arteries: A (systolic protruded), B (trapezoidal), C (sine waved), and D (diastolic-dominant biphasic). Functional gastroepiploic arteries showed A in 16 cases, B in 6, C in 31, and D in 48, with prevalence according to severity of stenosis in target coronary artery. Two occluded gastroepiploic arteries showed type A, and reverse or competitive flows were types A in 1, B in 1, C in 4, and D in 2. Relative to functional internal thoracic arteries, functional gastroepiploic arteries showed significantly lower minimum flow, higher insufficiency rate, and lower differentiated index of early diastolic flow.


CONCLUSIONS
Intraoperative transit-time flow profiles of patent in situ gastroepiploic arterial grafts were classified into four types, closely associated with disease severity of target coronary artery. Patent in situ gastroepiploic arterial grafts show more regurgitant flow and lower differentiated index of early diastolic flow than in situ internal thoracic arterial grafts.
Takami
Yoshiyuki
Y
Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. takami@nagoya2.jrc.or.jp
Tajima
Kazuyoshi
K
Terazawa
Sachie
S
Okada
Noritaka
N
Fujii
Kei
K
Sakai
Yoshimasa
Y
D000792:Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D011673:Pulsatile Flow; D013997:Time Factors; D014654:Vascular Patency