Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries

Autor: Masashi Takeshita, Masafumi Yashima, Eiki Nagaoka, Keiji Oi, Hirokuni Arai, Tsuyoshi Hachimaru, Taiju Watanabe, Minoru Tanabe, Hidehito Kuroki, Tatsuki Fujiwara, Kenji Sakai, Tomohiro Mizuno
Rok vydání: 2017
Předmět:
Pulmonary and Respiratory Medicine
Male
Reoperation
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Right gastroepiploic artery
Risk Assessment
Pancreaticoduodenectomy
Cohort Studies
03 medical and health sciences
0302 clinical medicine
In Situ Arterial Graft
Laparotomy
medicine.artery
medicine
Humans
Saphenous Vein
Coronary Artery Bypass
Digestive System Surgical Procedures
Aged
Retrospective Studies
business.industry
Anastomosis
Surgical

Graft Survival
Middle Aged
medicine.disease
Surgery
Survival Rate
surgical procedures
operative

medicine.anatomical_structure
Treatment Outcome
030228 respiratory system
Right coronary artery
Cholecystitis
Abdomen
Female
Patient Safety
Cardiology and Cardiovascular Medicine
business
Gastroepiploic Artery
Abdominal surgery
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 106(1)
ISSN: 1552-6259
Popis: Background The right gastroepiploic artery (GEA) is utilized as an excellent in situ arterial graft conduit to right coronary artery territory for coronary artery bypass grafting (CABG). However, there remain great concerns regarding the management of patients with a patent in situ GEA during abdominal surgery following CABG. Methods From 1995 to 2016, GEA was used for CABG in 278 patients at our institution. Of the patients, 14 abdominal surgeries were performed for subsequent abdominal diseases in 11 patients with a patent in situ GEA for CABG. We investigated the results of the surgeries and how to manage the GEAs in abdominal surgery. Results Laparotomy was required for gastric cancer in 3 patients, pancreatic cancer in 3, hepatic cancer in 2, cholangiocarcinoma in 1, duodenal papillary head cancer in 1, and cholecystitis in 1; multiple abdominal surgeries were needed in 2 patients for cancer recurrence and ileus. The intraabdominal adhesions around the GEAs were minimal in all patients. No graft injury occurred at the time of opening of the abdomen, and the planned procedures were completed without any circulatory problems. In 3 patients undergoing pancreaticoduodenectomy, intraabdominal off-pump rerouting of the GEA with a short saphenous vein was necessary for en bloc resection of the cancers and lymph nodes. There was neither operative mortality nor graft-related cardiac event except for 1 due to multiple organ failure. Conclusions Although intraabdominal rerouting of GEA is necessary for pancreaticoduodenectomy, abdominal surgery can be safely performed in patients with a patent in situ GEA coronary graft.
Databáze: OpenAIRE
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