title: Early and long-term patency of in situ skeletonized gastroepiploic artery after off-pump coronary artery bypass graft surgery.
abstract: BACKGROUND
  There is at present no accurate figure for the long-term patency rate of the skeletonized gastroepiploic artery (GEA).
  
  
  METHODS
  From January 2002 to July 2012, 956 consecutive patients underwent isolated off-pump coronary artery bypass graft (OPCABG) surgery at our institution. Of these, the 424 who underwent GEA grafting and postoperative GEA graft evaluation were the subjects of the present study. Of these 424 subjects, 155 (36.6%) underwent long-term outpatient evaluation using multidetector computed tomography angiography.
  
  
  RESULTS
  No patient was converted from off pump to on pump surgery. Overall 30-day mortality was 0.5% (2 of 424). The overall early (4 to 21 days after surgery) patency rate of the skeletonized GEA was 98.2% (599 of 610 anastomoses). A total of 215 GEA anastomoses, including 55 sequential bypasses, were followed for long-term evaluation, of which 12, including three sequential bypasses, were found to be occluded. The overall patency rate in skeletonized GEA grafting over a mean follow-up period of 73 months was 94.4% (203 of 215). The cumulative patency rate of the skeletonized GEA was 97.8% at 30 days, 96.7% at 1 year, 96.0% at 3 years, 94.7% at 5 years, and 90.2% at 8 years after surgery. Multivariate Cox proportional hazard regression analysis showed that target vessel stenosis (p = 0.008, hazard ratio 0.086, 95% confidence interval: 0.014 to 0.53) was the only independent predictor of late graft occlusion.
  
  
  CONCLUSIONS
  We demonstrated an accurate long-term patency rate for the skeletonized GEA superior to that for pedicled GEA or saphenous vein graft. A low-grade degree of target vessel stenosis was the only risk factor for late GEA occlusion.
authors.affiliation: Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan. suzukit@belle.shiga-med.ac.jp
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Tohru
authors.initials: T
authors.lastname: Asai
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Nota
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroyanagi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takashima
authors.forename: Masato
authors.initials: M
authors.lastname: Hayakawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014654:Vascular Patency