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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.
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Apr 1, 1996
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