Theoretical analysis of right gastroepiploic artery grafting to right coronary artery.

BACKGROUND The right gastroepiploic artery (GEA) has been used as the second reliable arterial graft for coronary artery bypass grafting (CABG). However, concern regarding the flow competition with the recipient coronary artery has remained. METHODS An application of in situ GEA grafting to the right coronary artery (RCA) was studied by using a theoretical model. The theoretical model of CABG was given variables; ie, the diameters and the lengths of both in situ GEA and proximal segment of the RCA, and the degree of proximal stenosis in the RCA. According to the range of these variables obtained from clinical data, the ratio of the GEA flow to the flow of the RCA distal to the anastomosis was calculated. RESULTS Main factors to determine the flows in the two parallel paths were the inner diameters of both vessels, and the degree of the proximal stenosis. When the inner diameters of the GEA were 0.5 mm larger than that of the RCA, the GEA carried more than 50% of the total flow of the RCA distal to the anastomosis despite a moderate stenosis in the RCA. When the inner diameter of the GEA was equal to, or 0.5 mm smaller than, that of the RCA, the GEA flow was dominated by the native RCA flow unless the proximal stenosis was critical. CONCLUSIONS If the inner diameter of the GEA is 0.5 mm larger than that of the RCA, CABG with the GEA can be applied more widely. If not, the application would basically be limited.

[1]  F. Smedts,et al.  Retrogastric versus antegastric routing and histology of the right gastroepiploic artery. , 1992, The Annals of thoracic surgery.

[2]  Y. Ikari,et al.  Effects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up. , 1996, The Journal of thoracic and cardiovascular surgery.

[3]  A. Voors,et al.  Low recurrence of angina pectoris after coronary artery bypass graft surgery with bilateral internal thoracic and right gastroepiploic arteries. , 1998, Circulation.

[4]  E. Larsen,et al.  Gastric arteriosclerosis in elderly people. , 1969, Scandinavian journal of gastroenterology.

[5]  A. Baue,et al.  Early and lage results of coronary revascularization with saphenous vein and internal mammary artery grafts. , 1979, American journal of surgery.

[6]  H. Suma,et al.  Availability of the in situ right gastroepiploic artery for coronary artery bypass. , 1992, The Annals of thoracic surgery.

[7]  F. Smedts,et al.  Comparative anatomic studies of various arterial conduits for myocardial revascularization. , 1990, The Journal of thoracic and cardiovascular surgery.

[8]  T. Nakao,et al.  Effect of coronary revascularization with the right gastroepiploic artery. Comparative examination of angiographic findings in the early postoperative period. , 1993, The Journal of thoracic and cardiovascular surgery.

[9]  P. Keto,et al.  Angiographic 5-year follow-up study of right gastroepiploic artery grafts. , 1996, The Annals of thoracic surgery.

[10]  V L Gott,et al.  Hemodynamics of aorta-to-coronary artery bypass. Experimental and analytical studies. , 1972, The Annals of thoracic surgery.

[11]  F. Menapace,et al.  Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery. , 1995, Circulation.

[12]  H. Barner,et al.  Double internal mammary-coronary artery bypass. , 1974, Archives of surgery.

[13]  J. C. Smith,et al.  Origin of downstream flow in nonobstructed coronary arteries. Influence of bypass grafts. , 1973, Archives of surgery.

[14]  G. Kakos,et al.  Coronary artery hemodynamics after aorto-coronary artery vein bypass. An experimental evaluation. , 1972, The Journal of thoracic and cardiovascular surgery.

[15]  M. Kawasuji,et al.  Pressure characteristics in arterial grafts for coronary bypass surgery. , 1995, Cardiovascular surgery.

[16]  B. Dincer,et al.  The "occluded" internal mammary artery graft: restoration of patency after apparent occlusion associated with progression of coronary disease. , 1983, The Journal of thoracic and cardiovascular surgery.

[17]  P. Brown,et al.  Right gastroepiploic-to-coronary artery bypass. The first decade of use. , 1995, Circulation.

[18]  H. Fukumoto,et al.  Coronary artery bypass grafting by utilizing in situ right gastroepiploic artery: basic study and clinical application. , 1987, The Annals of thoracic surgery.

[19]  T. Ivert,et al.  Angiographic studies of internal mammary artery grafts 11 years after coronary artery bypass grafting. , 1988, The Journal of thoracic and cardiovascular surgery.

[20]  N. Mills,et al.  Right gastroepiploic artery used for coronary artery bypass grafting. Evaluation of flow characteristics and size. , 1993, The Journal of thoracic and cardiovascular surgery.