Comparison of right internal thoracic artery and right gastroepiploic artery Y grafts anastomosed to the left internal thoracic artery.

Early and 1-year results of arterial Y composite grafts anastomosed to the in situ left internal thoracic artery were studied. Three hundred twelve patients who underwent off-pump coronary artery bypass using arterial Y composite grafts for revascularization of the left coronary artery territory were analyzed. A skeletonized right internal thoracic artery (RITA) or right gastroepiploic artery (RGEA) was anastomosed to the side of the left internal thoracic artery to construct a Y composite graft. Propensity-matched analysis was used to match patients using RITA (RITA group, n = 102) with patients using RGEA (RGEA group, n = 102). Postoperative coronary angiographies were performed early (200 of 204; 1.8 +/- 1.7 days) and 1 year (171 of 204, 11.3 +/- 2.5 months) postoperatively. There were no differences in postoperative mortalities (1 of 102 versus 2 of 102; p = 1.000) and morbidities including atrial fibrillation, mediastinitis, and perioperative myocardial infarction between the RITA and RGEA groups (not significant). Early and 1-year postoperative angiographies showed that there were no significant differences in patency rate between the two groups (early, 99.4% versus 99.3%; p = 1.000; 1-year, 95.4% versus 97.4%; p = 0.251). When the early and 1-year patency rates were compared based on the side-arm graft used, there were no differences in patency rates of RITA versus RGEA grafts between the two groups (early, 99.4% versus 100%; p = 1.000; 1-year, 96.5% versus 97.7%; p = 0.724). Construction of Y composite grafts using the RITA or RGEA showed comparable results including patency rates early and 1 year postoperatively.

Cho KR ，Hwang HY ，Kim JS ，Jeong DS ，Kim KB ... -  《-》

Equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts: five-year outcomes.

We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. Of 443 patients who underwent off-pump coronary revascularization exclusively using arterial Y-composite grafts, the RITA (n = 114) or RGEA (n = 329) was anastomosed to the side of the in situ left internal thoracic artery. A propensity score-matched analysis was used to match patients using the RITA (RITA group, n = 105) with patients using the RGEA (RGEA group, n = 105). Five-year angiographic patency rates and long-term clinical outcomes were compared. There were no differences in early mortality and postoperative complication rates between the RITA and RGEA groups. Five-year postoperative angiography showed no significant differences in overall graft patency (95.0% versus 95.1%; p = 0.895) and second-limb conduit patency (RITA versus RGEA, 93.4% versus 92.1%; p = 0.704) rates between the two groups. Propensity score-adjusted multivariable analysis revealed that previous history of percutaneous coronary intervention was the only significant risk factor for second-limb conduit occlusion at 5 years postoperatively (p = 0.003). No differences in overall survival (p = 0.703) and freedom from cardiac death (p = 0.968) rates were observed between the two groups. Reintervention-free survival (p = 0.236) and major adverse cardiac and cerebrovascular event-free survival (p = 0.704) rates were also similar between the two groups. Total arterial revascularization using RITA and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes.

Hwang HY ，Cho KR ，Kim KB 《-》

Right gastroepiploic artery for revascularization of the right coronary territory in off-pump total arterial revascularization: strategies to improve patency.

Kim KB ，Cho KR ，Choi JS ，Lee HJ ... -  《-》

Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery.

Graft selection for the right coronary artery territory remains controversial. The objective of this study was to analyze outcomes from revascularization of the right coronary artery territory using the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), or a saphenous vein graft (SVG). Between January 2001 and December 2010, 1,434 patients who underwent off-pump coronary artery bypass surgery using the bilateral mammary arteries were enrolled. Propensity score analysis was used to match patients who underwent revascularization of the right coronary artery territory with the RITA in a Y-composite fashion (RITA group, n=292), the RGEA (RGEA group, n=292), and the SVG (SVG group, n=292). Clinical and angiographic data were analyzed. There were no intergroup differences in terms of in-hospital mortality (0.3% [1 of 292], 0% [0 of 292], and 1% [3 of 292], p=0.332). Freedom from major adverse events including death, stoke, myocardial infarction, and reintervention at 10 years was similar among the three groups (87.8%±3.0% in the RITA group versus 92.4%±1.7% in the RGEA group versus 86.7%±3.4% in the SVG group; p=0.466). A stratified regression analysis showed that use of the saphenous vein was predictive of graft failure (p=0.044, hazard ratio 3.9). Proximal stenosis (<90%) was predictive of graft failure in the arterial groups (p=0.024, hazard ratio 3.1), but not in the SVG group (p=0.112). Arterial grafts should be considered the first choice for right coronary artery territory revascularization in off-pump coronary artery bypass. However, SVG should be considered when proximal stenosis is less than 90%.

Jeong DS ，Kim YH ，Lee YT ，Chung SR ，Sung K ，Kim WS ，Park PW ... -  《-》

Rationale for off-pump coronary revascularization to small branches--angiographic study of 1,283 anastomoses in 408 patients.

Matsuura K ，Kobayashi J ，Tagusari O ，Bando K ，Niwaya K ，Nakajima H ，Yagihara T ，Kitamura S ... -  《-》