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 ... -  《-》

Graft selection for the right coronary artery territory in off-pump coronary artery bypass.

The ideal bypass conduit in a right coronary artery (RCA) system remains controversial. We analyzed 121 patients who underwent off-pump coronary artery bypass with internal thoracic arteries for the left coronary artery system and either in situ a right gastroepiploic artery (RGEA; n = 66) or a saphenous vein graft (SVG; n = 55) for the RCA system were enrolled. Follow-up coronary computed tomographic angiographic data were reviewed. The RGEA group showed higher graft patency at 5 years, especially in high grade stenosis (≥ 80%; p = 0.009). In the SVG group, no difference was found between high grade stenosis and low grade stenosis. Freedom from adverse cardiac events at 5 years was higher in the RGEA group (p = 0.006). On multivariate analysis, low grade stenosis of RCA was predictive of graft failure (p = 0.029, hazard ratio = 10.9). In high grade stenosis of RCA, the RGEA group showed higher patency rate. The patency rate of SVG was not dependent on the degree of stenosis of RCA.

Jeong DS ，Lee HY ，Min HK ，Kim WS ，Sung K ，Park PW ，Lee YT ... -  《-》

Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique.

Kim WS ，Lee J ，Lee YT ，Sung K ，Yang JH ，Jun TG ，Park PW ... -  《-》

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 《-》

Angiographic predictors of 6-month patency of bypass grafts implanted to the right coronary artery a prospective randomized comparison of gastroepiploic artery and saphenous vein grafts.

Glineur D ，D'hoore W ，El Khoury G ，Sondji S ，Kalscheuer G ，Funken JC ，Rubay J ，Poncelet A ，Astarci P ，Verhelst R ，Noirhomme P ，Hanet C ... -  《-》