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Tjark Ebels - One of the best experts on this subject based on the ideXlab platform.
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exclusive use of arterial grafts in coronary Artery bypass operations for three vessel disease use of both thoracic arteries and the Gastroepiploic Artery in 256 consecutive patients
The Journal of Thoracic and Cardiovascular Surgery, 1996Co-Authors: Jan G Grandjean, Piet W Boonstra, Peter Den Heyer, Adriaan A Voors, Tjark EbelsAbstract:Abstract Methods: From September 1989 to September 1994 we operated on a consecutive group of 256 patients with three-vessel disease in whom we used the right Gastroepiploic Artery together with both internal thoracic arteries. Vein grafts were not used in these patients. This population consisted of 233 men and 23 women whose ages ranged from 31 to 77 years (mean age 57.8 years). Results: Hospital morbidity and mortality were not directly related to the use of the Gastroepiploic Artery. Patency of the anastomoses in a subgroup of 56 patients (22%) a mean of 16 months after the operation was 98% for the left internal thoracic Artery, 96% for the right internal thoracic Artery, and 88% for the Gastroepiploic Artery. Five-year actuarial survival (including in-hospital deaths) was 95.9% and was related only to age. From discharge until the end of follow-up, two patients had a myocardial infarction, six patients underwent a reintervention procedure, and 18 patients had a return of angina pectoris. Conclusion: We conclude that the concomitant use of the Gastroepiploic Artery with the both internal thoracic arteries has low morbidity and mortality in patients with three-vessel disease operated on by experienced surgeons. At this moment, we have no reason to believe graft patency will deteriorate in the future. On the basis of these results, the knowledge that arteries are to be preferred over veins for coronary bypass grafting, and the absence of a leg incision, we believe this operative technique is superior to the use of venous grafts. (J THORAC CARDIOVASC SURG 1996;112:935-42)
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coronary reoperation via small laparotomy using right Gastroepiploic Artery without cpb
The Annals of Thoracic Surgery, 1996Co-Authors: Jan G Grandjean, Massimo A Mariani, Tjark EbelsAbstract:The elective use of the right Gastroepiploic Artery as an in situ graft has been well established in coronary surgery. We propose a surgical technique for patients undergoing coronary reoperations with a patent mammary graft to the left anterior descending Artery. The Gastroepiploic Artery is used through a small laparotomy when only the right coronary Artery or the posterior descending Artery needs revascularization. The described technique allows avoidance of both resternotomy and cardiopulmonary bypass.
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arterial revascularization with the right Gastroepiploic Artery and internal mammary arteries in 300 patients
The Journal of Thoracic and Cardiovascular Surgery, 1994Co-Authors: Jan G Grandjean, Piet W Boonstra, Peter Den Heyer, Tjark EbelsAbstract:From September 1989 to September 1992, the right Gastroepiploic Artery in combination with one or both internal mammary arteries was used as a graft in 300 patients who underwent coronary Artery bypass grafting. The Gastroepiploic Artery was the primary choice in preference to the saphenous vein. The study comprised 263 men and 37 women, ranging in age from 31 to 77 years (median age 59 years). Thirty-nine patients (13 %) underwent previous bypass procedures with autologous vein grafts. In 17 patients (5.7%) the Gastroepiploic Artery was used as a single graft. In 150 patients (50%) the Gastroepiploic Artery in conjunction with one internal mammary Artery was used (in 6 patients combined with a vein graft). In 133 patients (44.3%) the Gastroepiploic Artery was used with both internal mammary arteries. Revascularization in nine patients (3 %) was combined with another cardiac procedure; three aortic valve replacements, two mitral valve repairs, and four resections of a left ventricular aneurysm. Ten patients died in the hospital (3.3%; 70% confidence limits 2.3% to 4.8%); two of these patients had an infarction in the area revascularized by the Gastroepiploic Artery. At late follow-up, 0.5 to 39 months (mean 14 months) after the operation, we found no mortality. One patient with an occluded Gastroepiploic Artery graft underwent reoperation with the use of the right internal mammary Artery. One patient underwent percutaneous transluminal coronary angioplasty of the right coronary Artery after occlusion of the Gastroepiploic Artery. Elective recatheterization was done in 88 patients 1 to 25 months after operation (mean 10 months). Graft patency in Gastroepiploic Artery grafts increased steadily from 77% in the first semester of the study to 95% in the fourth semester and then equaled the patency of the internal mammary Artery grafts (97 %), which was almost constant during the whole period. We conclude that patency of the Gastroepiploic Artery was initially related to a "learning curve" but eventually equaled that of the internal mammary Artery grafts. Furthermore, the Gastroepiploic Artery may well be the graft of choice in conjunction with the internal mammary arteries.
Hisayoshi Suma - One of the best experts on this subject based on the ideXlab platform.
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Twenty Years Experience With the Gastroepiploic Artery Graft for CABG
2016Co-Authors: Hisayoshi Suma, Tadashi IsomuraAbstract:Background—To improve the longterm outcome after CABG, several strategies have been used using arterial conduits. Our 20 years experience with the right Gastroepiploic Artery (GEA) graft was evaluated. Methods and Results—In 1352 patients having CABG with the GEA graft, (1092 men, mean 63 years, 99 % multivessel disease, and mean EF 0.51), internal thoracic Artery, saphenous vein, and radial Artery grafts were concomitantly used in 1312 (97%), 783 (58%), and 128 (8%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites for GEA grafting were 70 anterior descending, 268 circumflex, and 1089 right coronary arteries. The operative mortality was 1.26%. In 1118 follow-up patients (82.6%), 5, 10, and 15 years survival rates were 91.7%, 81.4%, and 71.3%, and the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 97.1 % at 1 month, 92.3 % at 1 year, 85.5 % at 5 years, and 66.5 % at 10 years, respectively. In 172 skeletonized GEA grafts with 233 distal anastomoses, the patency rate at immediate, 1, and 4 years after surgery was 97.6%, 92.9%, and 86.4%, respectively. In 124 patients with late (5 to 17 years) restudy, patency rate was 96 % (114/119) in the left internal thoracic Artery, 87 % (108/124) in GEA, and 68 % (67/98) in saphenous vein grafts. New stenosis was uncommon in GEA. Conclusion—The GEA graft is a safe and effective arterial conduit for CABG. (Circulation. 2007;116[suppl I]:I-188– I-191.) Key Words: ischemic heart disease myocardial revascularization coronary Artery bypass grafting Gastroepiploic Artery internal thoracic Artery To improve the longterm outcome after CABG, severalstrategies have been employed using arterial conduits.1,2 As a suitable alternative arterial conduit, the right gastroepi-ploic Artery (GEA) has been used and investigated widely.3,4,5 In this report, our 20 years experience with the GEA graft was evaluated
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the right Gastroepiploic Artery graft for coronary Artery bypass grafting a 30 year experience
The Korean Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Hisayoshi SumaAbstract:Throughout its 30-year history, the right Gastroepiploic Artery (GEA) has been useful for in situ grafts in coronary Artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary Artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic Artery and GEA grafts is an option for achieving better outcomes from CABG procedures.
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Gastroepiploic Artery graft in coronary Artery bypass grafting
Annals of cardiothoracic surgery, 2013Co-Authors: Hisayoshi SumaAbstract:The right Gastroepiploic Artery (GEA) has been recognized as a suitable and reliable conduit for coronary bypass surgery. From a sizable number of experiences, we know the use of this Artery does not increase surgical risk, and no gastric ischemia nor abdominal complications occur with takedown of the GEA. This Artery undergoes less significant arteriosclerosis and demonstrates physiological adaptability as seen in the internal thoracic Artery (ITA). From our experience with over 1,500 GEA grafts, the operative mortality was 1.26%, and 5-, 10-, and 15-year survival rates were 91.7%, 81.4%, and 71.3% respectively, while the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 98.5% at 1 month, 93.7% at 1 year, 86.2% at 5 years, and 70.2% at 10 years. The GEA graft is a safe and effective arterial conduit for coronary Artery bypass grafting (CABG).
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midterm results for use of the skeletonized Gastroepiploic Artery graft in coronary Artery bypass
Japanese Circulation Journal-english Edition, 2007Co-Authors: Hisayoshi Suma, Taiko Horii, Hiroaki Tanabe, Junya Yamada, Akiyoshi Mikuriya, Tadashi IsomuraAbstract:Background To improve the long-term results of coronary Artery bypass grafting (CABG), several arterial conduits have been used, including the skeletonized right Gastroepiploic Artery (GEA) graft. Methods and Results The skeletonized GEA graft was used for CABG in 223 patients over a 6-year period (208 males, 15 females, mean age 64 years). 1-, 2- and 3-vessel and left main trunk disease was noted in 1, 28, 122 and 72 patients, respectively. Internal thoracic Artery, radial Artery and saphenous vein grafts were concomitantly used in 217 (97%), 73 (33%) and 41 (18%) patients, respectively, and the mean number of grafts was 3.5. The sites of GEA grafting were 1 anterior descending, 10 diagonal, 97 circumflex, and 185 right coronary arteries, with 154 single in-situ, 33 free and 36 composite grafts, including 56 sequential grafts. There was 1 (0.4%) operative death. New Q wave was noted in 2 (0.9%) patients. Postoperative angiography revealed 97.6% early postoperative (within 1 month) and 91.5% midterm (mean 27 months) patency rates for GEA grafts. The cumulative 4-year patency rate of the skeletonized GEA graft was 86.4%. Conclusion The skeletonized GEA is a safe and effective arterial conduit for CABG. (Circ J 2007; 71: 1503 - 1505)
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twenty years experience with the Gastroepiploic Artery graft for cabg
Circulation, 2007Co-Authors: Hisayoshi Suma, Tadashi Isomura, Taiko Horii, Hiroaki Tanabe, Akihito Takahashi, Hitoshi Hirose, Atsushi AmanoAbstract:Background— To improve the longterm outcome after CABG, several strategies have been used using arterial conduits. Our 20 years experience with the right Gastroepiploic Artery (GEA) graft was evaluated. Methods and Results— In 1352 patients having CABG with the GEA graft, (1092 men, mean 63 years, 99% multivessel disease, and mean EF 0.51), internal thoracic Artery, saphenous vein, and radial Artery grafts were concomitantly used in 1312 (97%), 783 (58%), and 128 (8%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites for GEA grafting were 70 anterior descending, 268 circumflex, and 1089 right coronary arteries. The operative mortality was 1.26%. In 1118 follow-up patients (82.6%), 5, 10, and 15 years survival rates were 91.7%, 81.4%, and 71.3%, and the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 97.1% at 1 month, 92.3% at 1 year, 85.5% at 5 years, and 66.5% at 10 years, respectively. In 172 skeletonized GEA grafts with 233 distal anastomoses, the patency rate at immediate, 1, and 4 years after surgery was 97.6%, 92.9%, and 86.4%, respectively. In 124 patients with late (5 to 17 years) restudy, patency rate was 96% (114/119) in the left internal thoracic Artery, 87% (108/124) in GEA, and 68% (67/98) in saphenous vein grafts. New stenosis was uncommon in GEA. Conclusion— The GEA graft is a safe and effective arterial conduit for CABG.
Ki Bong Kim - One of the best experts on this subject based on the ideXlab platform.
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spasm and reopening of the right Gastroepiploic Artery conduit after coronary Artery bypass grafting
The Annals of Thoracic Surgery, 2017Co-Authors: Jae Hak Huh, Ho Young Hwang, Kwang Ree Cho, Kyung Hak Lee, Ki Bong KimAbstract:Background The right Gastroepiploic Artery (RGEA) has advantages for use as an arterial conduit in coronary Artery bypass graft surgery but perioperative spasm often develops. This study assessed the spasm and occlusion rates of RGEA conduits and elucidated the mechanism of reopening of occluded RGEA conduits. Methods Patients who received an RGEA conduit in coronary Artery bypass graft surgery were studied (n = 976; 700 composite, 276 in situ, 16 free grafts; 16 received both in situ and composite grafts). Early, 1-year, and 5-year angiographies were performed in 961 patients (98.5%), 815 patients (83.5%), and 618 patients (63.3%), respectively. Results Graft spasm was demonstrated in early angiograms in 72 proximal graft trunks of 1,608 distal anastomoses (4.5%) constructed using an RGEA conduit. Early occlusion rates of composite, in situ, and free RGEA conduits were 1.1%, 2.5%, and 0%, respectively; 8.5%, 7.5%, and 21.4%, respectively, at 1 year; and 10.5%, 14.1%, and 37.5%, respectively, at 5 years. Nineteen of 23 patients who had RGEA conduit occlusions at early angiography (1 occluded anastomosis per patient) were reevaluated at 1 year, and 9 of them (47.4%) had become patent. Of 83 patients with occluded RGEA composite grafts (90 occluded RGEA conduit anastomoses) at 1-year angiography, 8 were reopened at 5 years (8.9%). Progression of native target coronary Artery disease was observed in all 8 patients with reopened occluded RGEA conduits at 5 years but not in 9 patients with reopened RGEA conduits at 1 year. Conclusions Reopening of occluded RGEA conduits occurred early and midterm postoperatively. Reopening appeared related to recovery from graft spasm, and could occur as late as midterm if associated with progression of native coronary Artery disease.
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right Gastroepiploic Artery graft for myocardial revascularization prevalence of atherosclerosis and availability as a conduit
The Annals of Thoracic Surgery, 2011Co-Authors: Kwang Ree Cho, Ho Young Hwang, Jun Sung Kim, Ki Bong KimAbstract:Background We evaluated prevalence of atherosclerosis and availability of right Gastroepiploic Artery graft in patients undergoing coronary Artery bypass graft surgery. Methods Among the 1,579 patients who underwent isolated coronary Artery bypass grafting between January 1999 and December 2008, we opened the peritoneum to examine the right Gastroepiploic Artery for use as a graft in 1,128 patients (71.4%). A computer-based patient database system was utilized for this retrospective study. Results Of 1,128 patients, 139 patients (12.3%) had atherosclerotic right Gastroepiploic arteries at gross examination. Seventy-three of 139 atherosclerotic right Gastroepiploic arteries had multiple or diffuse atherosclerotic lesions that precluded their use as a bypass graft; the remaining 66 right Gastroepiploic arteries were used as a bypass graft including the atheromatous segment or after exclusion of the atherosclerotic segment. Another 60 nonatherosclerotic right Gastroepiploic arteries were unavailable to use as a graft because of their short length, small caliber, and weak pulsation. Overall availability of the right Gastroepiploic arteries as a graft was 88.2% (995 of 1,128). Multivariable logistic regression analysis showed older age (≥65 years; p Conclusions The prevalence of atherosclerosis and availability of the right Gastroepiploic Artery graft in patients undergoing isolated coronary Artery bypass grafting was 12.3% and 88.2%, respectively. Older age (≥65 years), insulin-treated diabetes mellitus, and chronic renal failure were identified as independent predictors for the atherosclerotic right Gastroepiploic Artery.
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Preserved Blood Flow in the Composite Right Gastroepiploic Artery Graft During Norepinephrine Infusion
The Annals of thoracic surgery, 2010Co-Authors: Ho Geol Ryu, Jae-hyon Bahk, Ki Bong KimAbstract:Background We examined the effect of norepinephrine infusion on blood flow in Y-composite right Gastroepiploic Artery grafts after off-pump coronary Artery bypass grafting. Methods Enrolled were 28 patients who were scheduled for revascularization with a Y-composite graft (end-to-side anastomosis of the right Gastroepiploic Artery to the in situ left internal thoracic Artery graft). After all planned anastomoses were completed in each patient, blood flow in the right Gastroepiploic Artery composite graft and the internal thoracic Artery graft (proximal and distal to the right Gastroepiploic Artery graft) was measured before and after continuous norepinephrine infusion. Results Blood flow in right Gastroepiploic Artery (26.4 ± 15.8 vs 33.8 ± 18.0 mL/min, p = 0.0004), proximal left internal thoracic Artery (47.5 ± 21.2 vs 61.6 ± 23.4 mL/min, p p p = 0.607). Conclusions Blood flow in right Gastroepiploic Artery composite grafts after off-pump coronary Artery bypass grafting was preserved during norepinephrine infusion.
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right Gastroepiploic Artery for revascularization of the right coronary territory in off pump total arterial revascularization strategies to improve patency
The Annals of Thoracic Surgery, 2006Co-Authors: Ki Bong Kim, Kwang Ree Cho, Jae Sung Choi, Hyun Joo LeeAbstract:Background We evaluated the early and 1-year postoperative results of grafting the skeletonized right Gastroepiploic Artery to the right coronary territories. Methods One hundred and seventy-five patients who underwent off-pump total arterial revascularization using the skeletonized right Gastroepiploic Artery and bilateral internal thoracic arteries were studied. The right Gastroepiploic Artery was used for revascularizing the right coronary territories, and bilateral internal thoracic arteries were used for revascularizing the left coronary territories. We revised the in-situ right Gastroepiploic Artery graft into a composite or free graft if the flowmeter measurement suggested a competitive flow pattern. Postoperative angiographies were performed in 98.3% of the patients before discharge, and in 92.0% of the patients 1 year after surgery. Results Hospital mortality was 0.6%. Postoperative angiography showed early patency rate of 98.3% for the right Gastroepiploic Artery and 99.4% for the internal thoracic Artery ( p = 0.352), and 1-year patency rate of 92.0% for the right Gastroepiploic Artery and 97.2% for the internal thoracic Artery ( p = 0.009). Flow competition of the right Gastroepiploic Artery was observed in 5.2% of the patients at the early postoperative angiography and in 6.8% of the patients 1 year after surgery. The incidence of right Gastroepiploic Artery graft flow competition was significantly decreased compared with that of the pre–flowmeter period ( p = 0.036 at early angiography; p = 0.017 at 1-year angiography). Conclusions The skeletonized right Gastroepiploic Artery grafted to the right coronary territory demonstrated excellent early and 1-year patency rates. Flow competition of the in situ right Gastroepiploic Artery may be overcome by intraoperative revision of graft based on flow measurement.
Jan G Grandjean - One of the best experts on this subject based on the ideXlab platform.
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exclusive use of arterial grafts in coronary Artery bypass operations for three vessel disease use of both thoracic arteries and the Gastroepiploic Artery in 256 consecutive patients
The Journal of Thoracic and Cardiovascular Surgery, 1996Co-Authors: Jan G Grandjean, Piet W Boonstra, Peter Den Heyer, Adriaan A Voors, Tjark EbelsAbstract:Abstract Methods: From September 1989 to September 1994 we operated on a consecutive group of 256 patients with three-vessel disease in whom we used the right Gastroepiploic Artery together with both internal thoracic arteries. Vein grafts were not used in these patients. This population consisted of 233 men and 23 women whose ages ranged from 31 to 77 years (mean age 57.8 years). Results: Hospital morbidity and mortality were not directly related to the use of the Gastroepiploic Artery. Patency of the anastomoses in a subgroup of 56 patients (22%) a mean of 16 months after the operation was 98% for the left internal thoracic Artery, 96% for the right internal thoracic Artery, and 88% for the Gastroepiploic Artery. Five-year actuarial survival (including in-hospital deaths) was 95.9% and was related only to age. From discharge until the end of follow-up, two patients had a myocardial infarction, six patients underwent a reintervention procedure, and 18 patients had a return of angina pectoris. Conclusion: We conclude that the concomitant use of the Gastroepiploic Artery with the both internal thoracic arteries has low morbidity and mortality in patients with three-vessel disease operated on by experienced surgeons. At this moment, we have no reason to believe graft patency will deteriorate in the future. On the basis of these results, the knowledge that arteries are to be preferred over veins for coronary bypass grafting, and the absence of a leg incision, we believe this operative technique is superior to the use of venous grafts. (J THORAC CARDIOVASC SURG 1996;112:935-42)
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coronary reoperation via small laparotomy using right Gastroepiploic Artery without cpb
The Annals of Thoracic Surgery, 1996Co-Authors: Jan G Grandjean, Massimo A Mariani, Tjark EbelsAbstract:The elective use of the right Gastroepiploic Artery as an in situ graft has been well established in coronary surgery. We propose a surgical technique for patients undergoing coronary reoperations with a patent mammary graft to the left anterior descending Artery. The Gastroepiploic Artery is used through a small laparotomy when only the right coronary Artery or the posterior descending Artery needs revascularization. The described technique allows avoidance of both resternotomy and cardiopulmonary bypass.
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arterial revascularization with the right Gastroepiploic Artery and internal mammary arteries in 300 patients
The Journal of Thoracic and Cardiovascular Surgery, 1994Co-Authors: Jan G Grandjean, Piet W Boonstra, Peter Den Heyer, Tjark EbelsAbstract:From September 1989 to September 1992, the right Gastroepiploic Artery in combination with one or both internal mammary arteries was used as a graft in 300 patients who underwent coronary Artery bypass grafting. The Gastroepiploic Artery was the primary choice in preference to the saphenous vein. The study comprised 263 men and 37 women, ranging in age from 31 to 77 years (median age 59 years). Thirty-nine patients (13 %) underwent previous bypass procedures with autologous vein grafts. In 17 patients (5.7%) the Gastroepiploic Artery was used as a single graft. In 150 patients (50%) the Gastroepiploic Artery in conjunction with one internal mammary Artery was used (in 6 patients combined with a vein graft). In 133 patients (44.3%) the Gastroepiploic Artery was used with both internal mammary arteries. Revascularization in nine patients (3 %) was combined with another cardiac procedure; three aortic valve replacements, two mitral valve repairs, and four resections of a left ventricular aneurysm. Ten patients died in the hospital (3.3%; 70% confidence limits 2.3% to 4.8%); two of these patients had an infarction in the area revascularized by the Gastroepiploic Artery. At late follow-up, 0.5 to 39 months (mean 14 months) after the operation, we found no mortality. One patient with an occluded Gastroepiploic Artery graft underwent reoperation with the use of the right internal mammary Artery. One patient underwent percutaneous transluminal coronary angioplasty of the right coronary Artery after occlusion of the Gastroepiploic Artery. Elective recatheterization was done in 88 patients 1 to 25 months after operation (mean 10 months). Graft patency in Gastroepiploic Artery grafts increased steadily from 77% in the first semester of the study to 95% in the fourth semester and then equaled the patency of the internal mammary Artery grafts (97 %), which was almost constant during the whole period. We conclude that patency of the Gastroepiploic Artery was initially related to a "learning curve" but eventually equaled that of the internal mammary Artery grafts. Furthermore, the Gastroepiploic Artery may well be the graft of choice in conjunction with the internal mammary arteries.
Ryuzo Sakata - One of the best experts on this subject based on the ideXlab platform.
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Gastroepiploic Artery Grafting Does Not Improve the Late Outcome in Patients With Bilateral Internal Thoracic Artery Grafting
The Annals of thoracic surgery, 2007Co-Authors: Jiro Esaki, Takaaki Koshiji, Minoru Okamoto, Masaki Tsukashita, Takeshi Ikuno, Ryuzo SakataAbstract:Background Bilateral internal thoracic Artery grafting in coronary Artery bypass surgery has a better long-term outcome than single internal thoracic Artery grafting. However, the efficacy of Gastroepiploic Artery (GEA) grafting in addition to bilateral internal thoracic Artery grafting is still not well-established. Methods From 1989 to 1999, 311 patients underwent coronary Artery bypass grafting using in situ bilateral internal thoracic arteries anastomosed to the left coronary arteries and either an in situ GEA or a saphenous vein graft (SVG) anastomosed to the right coronary Artery. Ninety-nine patients using the in situ GEA (GEA group) were compared with 212 patients using the SVG (SVG group) anastomsed to the right coronary Artery. Young patients and patients with hyperlipidemia were more prevalent in the GEA group. Results The seven-year survival rate in the GEA group and the SVG group were 94.7% and 87.2%, respectively ( p = 0.068). In a multivariate analysis, the age, renal failure, and a low ejection fraction ( p = 0.455). The seven-year freedom rates from recurrent angina were also similar between the groups (GEA group, 85.3%; SVG group, 88.8%; p = 0.700). Conclusions In comparison with SVG grafting, GEA grafting to the right coronary Artery did not significantly improve the late outcomes in patients with bilateral internal thoracic Artery grafting.
