Skeletonized right gastroepiploic artery for coronary artery bypass grafting; evaluation of intraoperative graft flow and postoperative angiographic result

We evaluated the efficacy of using the skeletonized right gastroepiploic artery (RGEA) in coronary artery bypass grafting (CABG). The RGEA was harvested either as a pedicle (group P, n = 14) or in a skeletonized fashion using a Harmonic Scalpel (group S, n = 14). The free flow of the RGEA was too small to be measured in some cases in group P. On the other hand, the free flow of the RGEA could be measured in all cases in group S, and that value obtained was comparable to the free flow of the left internal thoracic artery. The skeletonization of the RGEA also allowed us to directly visualize this vessel, and thus helped us to evaluate the quality of this artery. Postoperatively, all RGEAs were patent in both groups. The RGEA diameters on the postoperative angiography showed the RGEAs in group S to have a wider caliber, however, the differences in the values for each group did not reach statistic significance. Neither the operation time nor the postoperative hospital stay were substantially lengthened due to the skeletonization of the RGEA. In conclusion, the skeletonization of the RGEA using a Harmonic Scalpel is safe and effective modality which enables surgeons to directly visualize arteries in order to determine their quality and thereby making it easier to perform sequential bypass grafting. The method also demonstrated an excellent quality of the patent graft on postoperative angiography. We therefore consider the skeletonization of the RGEA to be a very useful method for harvesting the RGEA in CABG.