KẾT QUẢ SỚM PHẪU THUẬT BẮC CẦU MẠCH VÀNH CÓ DÙNG ĐỘNG MẠCH VỊ MẠC NỐI PHẢI

Abstract

Background: Total arterial coronary artery bypass grafting (CABG) provides durable myocardial revascularization and is associated with fewer complications compared to saphenous vein grafts. The left internal mammary artery to the left anterior descending artery is the gold-standard conduit. However, in multi-vessel disease, selecting a second or third arterial graft—such as the right gastroepiploic artery (RGEA)—is critical. RGEA has demonstrated clinical feasibility, particularly for grafting to the right coronary artery branches, yet concerns remain regarding its long-term patency. Off-pump CABG is increasingly preferred due to reduced risks of neurologic and renal complications, especially when using in-situ arterial grafts like RGEA. However, data on early outcomes of RGEA use in CABG remain limited in Vietnam. Objective: To evaluate the early outcomes of CABG using the RGEA graft. Methods: A retrospective study was conducted on 41 patients who underwent CABG with RGEA grafts at Cho Ray Hospital from January to December 2024. Clinical, surgical, and postoperative variables were collected and analyzed to assess efficacy and related complications. Results: The mean age was 58.4 ± 6.8 years; 82.9% underwent off-pump CABG; the mean preoperative left ventricular ejection fraction was 58.8%. RGEA was primarily used to graft right coronary artery branches with ≥90% stenosis. Three patients underwent sequential grafting with RGEA. No abdominal complications or early mortality were recorded. The most common postoperative complications were arrhythmia and pneumonia (each in 7.3% of patients). The average ICU stay was 45 hours. No neurologic events or in-hospital deaths were reported. Conclusion: RGEA is a safe and feasible arterial graft when appropriately selected and harvested with proper technique. It is particularly effective for revascularizing the RCA territory and supports the strategy of total arterial revascularization in CABG.