Harvesting of the Right Gastroepiploic Artery in CABG

This video presents the author’s technique for harvesting the right gastroepiploic artery (GEA) in coronary artery bypass grafting (CABG) (1).

After harvesting the mammary arteries, the peritoneum was opened and suspended by sutures. The stomach was exposed, and the GEA pulsations were checked. Using a low electrocautery blade, the GEA was identified along the great curvature. To harvest the GEA in a skeletonized manner, surgeons used a harmonic scalpel. Harvesting began in the midportion of the great curvature and continued throughout the distal section. When using a harmonic scalpel, the dissection can be carried out very close to the artery, thereby immediately assuring hemostasis without causing any spasm of the graft. 

Next, the harvesting was directed toward the proximal part of the GEA, taking great care to go down to the origin of the GEA from the gastroduodenal artery to achieve the maximal length of the graft. Finally, the last few centimeters of the distal part were dissected, stopping at around three quarters of the length of the stomach great curvature. The artery was divided using only the harmonic scalpel. As the GEA is a muscular artery and thus prone to spasm, intraluminal dilatation using dilute nitroprusside was mandatory. Before doing this, it is advised to put the patient in the Trendelenburg position to counter the small temporary hypotension caused by the administration of the vasodilator. 

In this instance, the GEA was wrapped in a warm gauze, diluted nitroprusside was applied on top of the graft, and the GEA was placed in the abdomen until it had to be used. After revascularization with the mammary arteries, a small opening in the diaphragm was made. The GEA was then tunneled into the pericardial space, ready to be anastomosed to the coronary artery.

References

1. Tavilla G, Bruggemans EF, Putter H. Twenty year outcomes of coronary artery bypass grafting utilizing three in-situ arterial grafts. J Thorac Cardiovasc Surg 2019;157:2228-36.

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