Early and mid-term outcome of anastomosis of gastroepiploic artery to left coronary artery

Background. The performance of a bypass made to the left coronary artery using the gastroepiploic artery was examined. Methods. Sixty-nine cases of bypass operation in which the gastroepiploic artery had been anastomosed to the left coronary artery at least 3 years prior were examined. All cases were performed by the same surgeon during the period from April 1989 to April 2000. Performance immediately after the operation and performance at least 3 years after the operation were examined on the basis of graft patency rate. Results. Graft patency rates in cases with an anastomosis to the left anterior descending coronary artery and cases with an anastomosis to the circumflex artery were favorable immediately after the operation, at 96.0% (24 of 25) and 100% (18 of 18), respectively. However, over the mid-term, the patency rate dropped to 58.8% (10 of 17) in cases with an anastomosis to the left anterior descending artery, and two cases of cardiogenic sudden deaths occurred during the course of follow-up. The graft patency rate in cases with an anastomosis to the circumflex artery, on the other hand, remained favorable, at 93.3% (14 of 15). In a sequential bypass grafting through the right coronary artery, the graft between the left anterior descending coronary artery and the right coronary artery was closed, and the graft patency rate between the right coronary artery and the circumflex artery was 71.4% (10 of 14). Conclusions. The mid-term patency rate was poor for cases in which the gastroepiploic artery had been anastomosed to the left anterior descending coronary artery, which suggests that the procedure should be avoided. On the other hand, the patency rate was relatively favorable when the gastroepiploic artery had been anastomosed to the circumflex artery. (C) 2004 by The Society of Thoracic Surgeons.