Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Editorial comment

Editorial comment References 1. Dignan RJ, Yeh T, Dyke CM, Lee KF, 2. Mills NL, Hockmuth DR, Everson CT, Suma H, Wanibuchi Y, Terada Y, Fuku- Lutz HA, Ding M, Wechsler AS (1992) Robart CC (1993) Right gastroepiploc da S, Takayama T, Furuta S (1993) The Reactivity of gastroepiploic and internal artery used for coronary artery bypass right gastroepiploic artery graft. Clini- mammary arteries. J Thorac Cardiovasc grafting. Evaluation of flow characteris- cal and angiographic mid-term results in Surg 103:116-123 tics and size. J Thorac Cardiovasc Surg 200 patients. J Thorac Cardiovasc Surg 106:579-586 105:615-623 R. Dion The right gastroepiploic artery ragmatic passage, and the surprising 4, In cases of cardiac reoperation, (GEA) has now gained a wide recog- possibility of herniation of abdomi- lifting the heart out of the pericar- nal organs through the diaphragmatic dium - already not easy when a nition, beside the internal mammyry arteries, as a bypass graft for myo- orifice which has recently be re- "long" GEA pedicle has been used - would be totally precluded. cardial revascularization. Its harvest- ported by a few authors. ing hardly prolongs the midline ster- The authors describe a gastropexy I would therefore not recommend the in which the greater curvature of the notomy incision and specific postop- systematic use of this method. I erative morbidity is nearly absent. It stomach is sutured to the undersur- would bear in mind for use in partic- face of the diaphragm at the site can be used as a pedicled graft and ular circumstances, like after previ- can reach any of the coronary seg- where the gastroepiploic artery is ous upper abdominal surgery when ments in the vast majority of the brought through if for coronary anas- harvesting a GEA full length pedicle cases. Mid-term patency rates of tomoses. This maneuvre shortens the may be rather tricky, or when only a distance which the gastroepiploic ar- more than 90% have been recently short GEA suitable segment is avail- tery must travel. It certainly prevents reported in large series of patients. able, or maybe when a not optimally At our Institution, about 25% of the injury of the graft should abdominal developed GEA has to be used for surgery be required at a later stage, patients currently receive a GEA grafting a dominant right coronary and herniation of the abdominal or- graft: we use it mainly to graft the artery or circumflex. gans through the diaphragmatic ori- distal right coronary artery (RCA) Nevertheless I wish to commend and its branches, and the distal cir- fice. the authors upon their original idea However I fear the following draw- cumflex system. Right gastroepiploic and intentiveness, and I look forward artery is particularly helpful in redos backs: to reading a report of their larger ex- and as an alternative conduit to the perience with this technical modifi- 1. Some of the gastropexis will right internal mammary artery when cation in the future. loosen, with nasty consequences. sternal complications of bilateral 2. A few patients may experience at mammary artery are a concern. least some "gastric" discomfort. Among the not so frequent inconven- iences let us mention its harvesting, 3. In case of ulterior abdominal sur- R. Dion gery, a stomach whose greater curva- which can turn tedious in obese pa- Department of Cardiovascular ture is irremediably adherent to the tients and in the presence of abdomi- and Thoracic Surgery, diaphragm will sometimes represent nal adhesions, the inconstancy of ist Cliniques Universitaires Saint-Luc, a considerable hindrance for the sur- useable length and distal caliber, the Avenue Hippocrate, 10, B-1200 Brussels, Belgium hazard of kinking at the transdiaph- geon. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Editorial comment

European Journal of Cardio-Thoracic Surgery , Volume 10 (4) – Apr 1, 1996

Loading next page...
 
/lp/oxford-university-press/editorial-comment-SQYu0ALFy0

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Oxford University Press
Copyright
© Springer-Verlag 1996
Subject
Articles
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/S1010-7940(96)80157-6
Publisher site
See Article on Publisher Site

Abstract

References 1. Dignan RJ, Yeh T, Dyke CM, Lee KF, 2. Mills NL, Hockmuth DR, Everson CT, Suma H, Wanibuchi Y, Terada Y, Fuku- Lutz HA, Ding M, Wechsler AS (1992) Robart CC (1993) Right gastroepiploc da S, Takayama T, Furuta S (1993) The Reactivity of gastroepiploic and internal artery used for coronary artery bypass right gastroepiploic artery graft. Clini- mammary arteries. J Thorac Cardiovasc grafting. Evaluation of flow characteris- cal and angiographic mid-term results in Surg 103:116-123 tics and size. J Thorac Cardiovasc Surg 200 patients. J Thorac Cardiovasc Surg 106:579-586 105:615-623 R. Dion The right gastroepiploic artery ragmatic passage, and the surprising 4, In cases of cardiac reoperation, (GEA) has now gained a wide recog- possibility of herniation of abdomi- lifting the heart out of the pericar- nal organs through the diaphragmatic dium - already not easy when a nition, beside the internal mammyry arteries, as a bypass graft for myo- orifice which has recently be re- "long" GEA pedicle has been used - would be totally precluded. cardial revascularization. Its harvest- ported by a few authors. ing hardly prolongs the midline ster- The authors describe a gastropexy I would therefore not recommend the in which the greater curvature of the notomy incision and specific postop- systematic use of this method. I erative morbidity is nearly absent. It stomach is sutured to the undersur- would bear in mind for use in partic- face of the diaphragm at the site can be used as a pedicled graft and ular circumstances, like after previ- can reach any of the coronary seg- where the gastroepiploic artery is ous upper abdominal surgery when ments in the vast majority of the brought through if for coronary anas- harvesting a GEA full length pedicle cases. Mid-term patency rates of tomoses. This maneuvre shortens the may be rather tricky, or when only a distance which the gastroepiploic ar- more than 90% have been recently short GEA suitable segment is avail- tery must travel. It certainly prevents reported in large series of patients. able, or maybe when a not optimally At our Institution, about 25% of the injury of the graft should abdominal developed GEA has to be used for surgery be required at a later stage, patients currently receive a GEA grafting a dominant right coronary and herniation of the abdominal or- graft: we use it mainly to graft the artery or circumflex. gans through the diaphragmatic ori- distal right coronary artery (RCA) Nevertheless I wish to commend and its branches, and the distal cir- fice. the authors upon their original idea However I fear the following draw- cumflex system. Right gastroepiploic and intentiveness, and I look forward artery is particularly helpful in redos backs: to reading a report of their larger ex- and as an alternative conduit to the perience with this technical modifi- 1. Some of the gastropexis will right internal mammary artery when cation in the future. loosen, with nasty consequences. sternal complications of bilateral 2. A few patients may experience at mammary artery are a concern. least some "gastric" discomfort. Among the not so frequent inconven- iences let us mention its harvesting, 3. In case of ulterior abdominal sur- R. Dion gery, a stomach whose greater curva- which can turn tedious in obese pa- Department of Cardiovascular ture is irremediably adherent to the tients and in the presence of abdomi- and Thoracic Surgery, diaphragm will sometimes represent nal adhesions, the inconstancy of ist Cliniques Universitaires Saint-Luc, a considerable hindrance for the sur- useable length and distal caliber, the Avenue Hippocrate, 10, B-1200 Brussels, Belgium hazard of kinking at the transdiaph- geon.

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Apr 1, 1996

There are no references for this article.