Albertini A, Lochegnies A, El Khoury G, Verhelst R, Noirhomme P, Matta A, Jacquet L, Underwood M J, Dion R
Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
Cardiovasc Surg. 1998 Aug;6(4):419-23. doi: 10.1016/s0967-2109(98)00009-x.
From October 1988 to October 1995 the right gastroepiploic artery was used as a conduit for coronary surgery in 307 patients. Their average age was 56.5 years (range 25-75) and 274 patients (89%) were male. Twenty-six cases (8.5%) were re-operations and 58 patients (19%) were operated upon on an urgent or semi-urgent basis. Target coronary vessels were the right coronary artery and its branches in 280 cases (91.4%), the circumflex artery in 25 cases (8%) and the left anterior descending artery in two cases. The right gastroepiploic artery was used as an in situ graft in 303 cases (98.7%) and as a free graft in 4 (1.3%). A total of 291 patients (94.8%) also received at least one mammary artery graft: both mammary arteries were used in 167 patients (54.4%). An average of 3.6 distal anastomoses were made per patient, three of them with arterial grafts. Eleven (3.2%) right gastroepiploic artery grafts were doubled with saphenous vein intraoperatively because of persistent myocardial ischemia. In-hospital mortality was 1.6% (five patients). Perioperative myocardial infarction occurred in twelve patients (3.9%). Follow-up now averages 26 months (range 6-88). There have been five late deaths (1.6%). A total of 265 (89.2%) patients are angina free. Of the total, 145 patients have been investigated with a maximal-stress test coupled with scintigraphy: residual myocardial ischemia was found in 10 patients, right gastroepiploic artery was related in three. Ninety-six patients have undergone angiographic restudy at a mean of 12 months (range 8-88) postoperatively. Patency of the right gastroepiploic artery grafts was 91.8%. This study confirms that the right gastroepiploic artery can be used as a conduit for coronary artery bypass surgery with minimal mortality or morbidity. Mid-term patency rates and clinical outcome are encouraging.
1988年10月至1995年10月期间，307例患者在冠状动脉手术中使用了胃网膜右动脉作为血管移植物。患者平均年龄为56.5岁（范围25 - 75岁），其中274例（89%）为男性。26例（8.5%）为再次手术，58例（19%）为急诊或亚急诊手术。目标冠状动脉血管为右冠状动脉及其分支280例（91.4%），回旋支动脉25例（8%），左前降支动脉2例。胃网膜右动脉原位移植303例（98.7%），游离移植4例（1.3%）。共有291例患者（94.8%）至少接受了一根乳内动脉移植物：167例患者（54.4%）使用了双侧乳内动脉。每位患者平均进行3.6次远端吻合，其中3次使用动脉移植物。11例（3.2%）胃网膜右动脉移植物因持续心肌缺血术中与大隐静脉进行了双吻合。住院死亡率为1.6%（5例患者）。围手术期心肌梗死发生在12例患者（3.9%）。目前随访平均26个月（范围6 - 88个月）。有5例晚期死亡（1.6%）。共有265例（89.2%）患者无心绞痛。在所有患者中，145例患者接受了最大负荷试验联合心肌灌注显像检查：10例患者发现残余心肌缺血，其中3例与胃网膜右动脉有关。96例患者在术后平均12个月（范围8 - 88个月）进行了血管造影复查。胃网膜右动脉移植物通畅率为91.8%。本研究证实胃网膜右动脉可作为冠状动脉旁路移植术的血管移植物，死亡率和发病率极低。中期通畅率和临床结果令人鼓舞。
