caa a22 4500 39749596X CHVBK 20180308164521.0 cr unu---uuuuu 161202e199510 xx s 000 0 eng 10.1016/S1010-7940(05)80009-0 doi (NATIONALLICENCE)oxford-10.1016/S1010-7940(05)80009-0 Technical aspects and late functional results of gastroepiploic bypass grafting (400 cases) [Elektronische Daten] From January 1990 to February 1994, 400 patients (mean age 59 +/- 9years) underwent myocardial revascularization using the rightgastroepiploic artery (GEA) to bypass the right coronary artery trunk orbranches. They represented 40% of all patients undergoing isolated coronarysurgery during the same period, from 19% in 1990 to 54% in 1994. Leftventricular function was normal in 32% of patients, moderately impaired in62% and severely impaired in 6%. The GEA was used alone in six patients,associated with one internal mammary artery (IMA) in 111 patients (twoarterial grafts, 2.2 +/- 0.4 anastomoses) and with both IMAs in 283patients (three arterial grafts, 3.4 +/- 0.6 anastomoses); no vein graftwas used. The rate of complete myocardial revascularization was 79%. Earlymortality was 1.7% and influenced by left ventricular ejection fraction (P< 0.05). Complications occurred in 37 patients: myocardial infarction4%, intra-aortic balloon pump 0.5%, reoperation for bleeding 0.5%,mediastinitis 0.25%. Early (15th postoperative day) angiographic control ofthe GEA graft was performed in 104 patients operated from January 1990 toDecember 1991 and the patency rate was 92%; anomalies of GEA were threeocclusions, five stenoses, three competitive flow, no string or slendersign. Early functional results (3 +/- 1 months postoperatively) werestudied in 192 patients during exercise test with medical treatment: 99%were symptom- free and 14% had electrocardiographic (ECG) ischemicmodification significantly correlated with incomplete revascularization (P< 0.01). The 2- and 4-year actuarial survival rate was 96.7 +/- 1.9%.The rate of late cardiac events was 2% patient/year; Angioplasty for GEAgraft failure was required in four patients. A 2-year postoperativefunctional assessment without medical treatment was performed duringexercise test in 66 patients who had received three arterial grafts: 98%were symptom-free and 26% had ECG ischemic modification significantlycorrelated with incomplete revascularization (P < 0.01); during the sameprocedure, thallium myocardial scintigraphy was obtained in 50 patients: 18patients (36%) had asymptomatic ischemic defects on exercise significantlycorrelated with incomplete revascularization and ECG ischemic changes (P< 0.01). However, posterior thallium defects demonstrated limited GEAflow at the maximum level of exercise in at least 8% of patients.Myocardial revascularization using the GEA can be achieved with minimaloperative risk and offers satisfactory functional results and midtermsurvival rate. © Springer-Verlag European Journal of Cardio-Thoracic Surgery Elsevier Science B.V. 9/10(1995-10), 575-580 1010-7940 9:10<575 1995 9 ejcts https://doi.org/10.1016/S1010-7940(05)80009-0 text/html Onlinezugriff via DOI 1 abstract jats NATIONALLICENCE 856 40 https://doi.org/10.1016/S1010-7940(05)80009-0 text/html Onlinezugriff via DOI NATIONALLICENCE 773 0- European Journal of Cardio-Thoracic Surgery Elsevier Science B.V 9/10(1995-10), 575-580 1010-7940 9:10<575 1995 9 ejcts Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford