[A method for determining an appropriate length of gastroepiploic artery graft in off-pump coronary artery bypass grafting].

ABSTRACT

The gastroepiploic artery (GEA) is available as a graft to the right coronary artery (RCA). However, it is hard to determine an optimal anastomotic site and GEA graft length after upsetting the heart in off-pump coronary artery bypass grafting (OPCAB). To solve these problems, we traced a target coronary tree on the diaphragm and marked an optimal anastomotic site by skin markers. A small incision was made on the diaphragm at the proximal site of the optimal anastomotic position. Appropriate length of GEA graft was determined according to the schema on the diaphragm. By postoperative coronary angiogram performed in 22 cases (25 anastomoses), 22 anastomoses proved patent (88.0%). Flow competition of GEA-4 posterior descending artery (PD) was observed in 2 anastomoses (8.0%). Occlusion of 4PD-4 atrioventricular node artery (AV) sequential portion was observed in 1 anastomosis (4.0%). There was no angulated, redundant or tense graft in any of the patent grafts. This method was suggested to be useful in determining an optimal anastomotic site and GEA graft length.