Graft selection for the right coronary artery territory in off-pump coronary artery bypass
Dong Seop Jeong1, Hae Young Lee, Ho Ki Min
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Republic of Korea.
Insights
For right coronary artery bypass, the right gastroepiploic artery (RGEA) graft shows superior 5-year patency compared to saphenous vein grafts (SVG), particularly in high-grade stenosis cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease
Background:
- The optimal bypass conduit for the right coronary artery (RCA) remains debated.
- Internal thoracic arteries are standard for the left coronary system.
Purpose of the Study:
- To compare the efficacy of right gastroepiploic artery (RGEA) versus saphenous vein graft (SVG) for RCA bypass.
- To evaluate graft patency and freedom from adverse cardiac events at 5 years.
Main Methods:
- Retrospective analysis of 121 patients undergoing off-pump coronary artery bypass.
- Patients received internal thoracic arteries for the left system and either RGEA (n=66) or SVG (n=55) for the RCA.
- Follow-up via coronary computed tomographic angiography.
Main Results:
- RGEA grafts demonstrated higher 5-year patency, especially in high-grade (≥80%) RCA stenosis (p=0.009).
- SVG patency was not significantly different between high and low-grade stenosis.
- Higher freedom from adverse cardiac events was observed in the RGEA group (p=0.006).
- Low-grade RCA stenosis predicted graft failure (HR=10.9, p=0.029).
Conclusions:
- RGEA grafts offer superior patency in high-grade RCA stenosis compared to SVG.
- SVG graft patency is independent of the degree of RCA stenosis.
- RGEA appears to be a favorable conduit for RCA revascularization in specific stenosis scenarios.
Background:
The ideal bypass conduit in a right coronary artery (RCA) system remains controversial.
Methods:
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.
Results:
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).
Conclusions:
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.
More Related Videos
12:17Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023