Graft of choice to right coronary system in left-sided bilateral internal thoracic artery grafting
Oren Lev-Ran1, Rephael Mohr, Gideon Uretzky
1Department of Cardiothoracic Surgery, The Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. orenlevran@hotmail.com
Insights
For patients receiving bilateral internal thoracic artery grafts, using the right gastroepiploic artery (RGEA) for the right coronary system offers no advantage over the saphenous vein graft (SVG) in mid-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Determining the optimal graft for the right coronary artery in patients undergoing bilateral internal thoracic artery (BITA) grafting is crucial.
- Saphenous vein graft (SVG) and right gastroepiploic artery (RGEA) were compared as supplemental conduits to the right coronary artery following BITA grafting.
Purpose of the Study:
- To compare the efficacy and safety of RGEA versus SVG as a supplemental graft to the right coronary artery in patients undergoing BITA grafting.
Main Methods:
- A retrospective study compared 234 patients who received BITA grafting with RGEA to the posterior descending artery (RGEA group) against 127 patients who received BITA grafting with SVG to the right coronary system (SVG group).
- Patient demographics, perioperative outcomes, and midterm survival rates were analyzed.
Main Results:
- The SVG group had a higher prevalence of female sex, diabetes, emergency cases, and left main coronary artery disease.
- Thirty-day mortality and postoperative complication rates were similar between the RGEA and SVG groups.
- Midterm follow-up (up to 56 months) revealed comparable 1-year and 4-year survival rates for both groups.
Conclusions:
- The use of RGEA for right coronary system revascularization in conjunction with BITA grafting does not provide superior clinical benefits compared to SVG after midterm follow-up.
- Both RGEA and SVG are viable options for supplemental grafting to the right coronary artery in this patient population.
Background:
The complementary graft of choice to the right coronary artery system in patients undergoing left-sided bilateral internal thoracic artery grafting has yet to be determined. Saphenous vein graft (SVG) was compared with right gastroepiploic artery (RGEA) as the supplemental conduit to the right coronary artery when left-sided bilateral internal thoracic artery grafting is implemented.
Methods:
From April 1996 to July 1999, 234 patients underwent bilateral internal thoracic artery grafting to the left coronary system with RGEA grafted to the posterior descending artery (RGEA group). They were compared with 127 patients with left-sided bilateral internal thoracic artery in whom SVG was used for grafting the right coronary system (SVG group).
Results:
Female sex (27% versus 14.5%), diabetic patients (40% versus 27%), emergency cases (21% versus 7.3%), and left main coronary artery disease (34% versus 23%) were more prevalent in the SVG group. Number of grafts per patient was higher in the SVG group (3.8 versus 3.5, p = 0.04). Thirty-day mortality was 3.9% in the SVG and 2.6% in the RGEA group (not significant). Occurrence of postoperative complications (myocardial infarctions, strokes, bleeding, and sternal infections) was similar. Return of angina was similar (1.6% versus 3.8% in the SVG and RGEA groups, respectively). Midterm follow-up (4 to 56 months) showed comparable 1-year and 4-year survival (Kaplan-Meier) for both groups (92.8% and 91.7% in the SVG group, and 94.7% and 88% in the RGEA group, respectively).
Conclusions:
In patients undergoing left-sided bilateral internal thoracic artery grafting, the use of RGEA for revascularization of the right coronary system does not confer clinical benefits over SVG after midterm follow-up.
