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%.