Theoretical analysis of right gastroepiploic artery grafting to right coronary artery Kenzo Yasuura, MD, Yasushi Takagi, MD, Yasuhisa Ohara, MD, Yoshiyuki.

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Presentation transcript:

Theoretical analysis of right gastroepiploic artery grafting to right coronary artery Kenzo Yasuura, MD, Yasushi Takagi, MD, Yasuhisa Ohara, MD, Yoshiyuki Takami, MD, Akio Matsuura, MD, Hiroshi Okamoto, MD The Annals of Thoracic Surgery Volume 69, Issue 3, Pages 728-731 (March 2000) DOI: 10.1016/S0003-4975(99)01401-0

Fig 1 Theoretical model for mathematical concept. Two paths stem from the aorta in parallel. (Ao = aorta; CA = right coronary artery (RCA); GEA = gastroepiploic artery; Lg = length of GEA pedicle; Lc = length of coronary artery from origin to anastomotic site; Ls = length of stenotic lesion (3 mm); Dg = diameter of GEA; Dc = diameter of RCA; Ds = diameter of stenotic lesion.) The Annals of Thoracic Surgery 2000 69, 728-731DOI: (10.1016/S0003-4975(99)01401-0)

Fig 2 The diameters of the GEA and the RCA are 2.5 and 2.0 mm, respectively. (Left) The GEA is assumed to be bypassed to the distal portion of the RCA (Lc = 10 cm). As the GEA has the larger caliber, compared with the RCA, the GEA can provide more than 50% of the total flow of the RCA distal to the anastomosis. The GEA flow dominates the flow of the proximal segment of the RCA even in the range of low degrees of stenosis. (Right) If anastomosed distally (Lc = 15 cm), the GEA is assumed to be bypassed to the posterior descending artery. The Annals of Thoracic Surgery 2000 69, 728-731DOI: (10.1016/S0003-4975(99)01401-0)

Fig 3 The diameters of the GEA and the RCA are 2.0 and 1.5 mm, respectively. The relation of the diameters of both the GEA and the RCA with the proximal stenosis is nearly the same as in Figure 2. The GEA can provide more than 50% of the total flow of the RCA distal to the anastomosis, even in the range of low degrees of stenosis. The Annals of Thoracic Surgery 2000 69, 728-731DOI: (10.1016/S0003-4975(99)01401-0)

Fig 4 The diameters of the GEA and the RCA are 1.5 and 2.0 mm, respectively. Even if the anastomotic site is proximal or distal, the GEA flow is dominated by the flow of the proximal segment of the RCA in the range of up to 91% cross-sectional stenosis, except for the shortest graft (Lg = 15 cm). The flow of the proximal segment of the RCA dominates that of the GEA unless the proximal stenosis in the RCA is severe. The Annals of Thoracic Surgery 2000 69, 728-731DOI: (10.1016/S0003-4975(99)01401-0)

Fig 5 The diameters of both the GEA and the RCA are 2.0 mm. (Left) When anastomosed proximally, the flow through the GEA can dominate that of the proximal segment of the RCA in the range of more than 84% of proximal stenosis. (Right) However, when distally anastomosed, the GEA flow can dominate in the range of more than 75% of proximal stenosis. The Annals of Thoracic Surgery 2000 69, 728-731DOI: (10.1016/S0003-4975(99)01401-0)