Exclusive use of arterial grafts in coronary artery bypass operations for three-vessel disease: Use of both thoracic arteries and the gastroepiploic artery in 256 consecutive patients

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 112; no. 4; pp. 935 - 942
• Main Authors: Grandjean, Jan G., Voors, Adriaan A., Boonstra, Piet W., Heyer, Peter den, Ebels, Tjark
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.10.1996; AATS/WTSA; Elsevier
• Subjects: Adult; Aged; Arteries - transplantation; Atrial Fibrillation - etiology; Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Disease - pathology; Coronary Disease - surgery; Coronary heart disease; Female; Heart; Humans; Infant; Logistic Models; Male; Medical sciences; Middle Aged; Omentum - blood supply; Postoperative Complications; Risk Factors; Stomach - blood supply; Survival Rate; Thoracic Arteries - transplantation; Vascular Patency; Human; Cardiovascular disease; Transplantation; Coronary heart disease; Artery; Autotransplantation; Result; Treatment; Aortocoronary; Bypass; Surgery; Internal mammary artery; Comparative study
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(96)70093-4

Methods: From September 1989 to September 1994 we operated on a consecutive group of 256 patients with three-vessel disease in whom we used the right gastroepiploic artery together with both internal thoracic arteries. Vein grafts were not used in these patients. This population consisted of 233 men and 23 women whose ages ranged from 31 to 77 years (mean age 57.8 years). Results: Hospital morbidity and mortality were not directly related to the use of the gastroepiploic artery. Patency of the anastomoses in a subgroup of 56 patients (22%) a mean of 16 months after the operation was 98% for the left internal thoracic artery, 96% for the right internal thoracic artery, and 88% for the gastroepiploic artery. Five-year actuarial survival (including in-hospital deaths) was 95.9% and was related only to age. From discharge until the end of follow-up, two patients had a myocardial infarction, six patients underwent a reintervention procedure, and 18 patients had a return of angina pectoris. Conclusion: We conclude that the concomitant use of the gastroepiploic artery with the both internal thoracic arteries has low morbidity and mortality in patients with three-vessel disease operated on by experienced surgeons. At this moment, we have no reason to believe graft patency will deteriorate in the future. On the basis of these results, the knowledge that arteries are to be preferred over veins for coronary bypass grafting, and the absence of a leg incision, we believe this operative technique is superior to the use of venous grafts. (J T HORAC C ARDIOVASC S URG 1996;112:935-42)