Remote Targets for Right Coronary Artery Bypass: Distal Trunk or Posterior Descending Artery Grafting
Murat C Songur1, Kerem M Vural1, Burak Erdolu1
1Cardiovascular Surgery Department, Yuksek Ihtisas Hospital of Turkey, Ankara, Turkey.
Insights
Choosing the distal right main coronary artery (DRCA) for bypass grafting offers better long-term saphenous vein graft (SVG) patency compared to the right posterior descending coronary artery (RPDA). This finding is crucial for surgical revascularization of the right coronary artery system.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Optimal anastomotic site selection is critical for successful surgical revascularization of the right coronary artery (RCA) system.
- Distal or sequential main trunk disease often necessitates targeting the right posterior descending coronary artery (RPDA) or the distal right main coronary artery (DRCA).
- This study compares the long-term patency of saphenous vein grafts (SVGs) between these two primary target vessels.
Purpose of the Study:
- To compare the long-term saphenous vein graft (SVG) patency rates when the distal right main coronary artery (DRCA) is used as the target vessel versus the right posterior descending coronary artery (RPDA).
- To identify factors influencing long-term graft patency in patients with distal right coronary artery disease undergoing bypass grafting.
Main Methods:
- A retrospective analysis of 452 patients undergoing conventional on-pump coronary artery bypass grafting.
- Patients received either a DRCA graft (n=305) or an RPDA graft (n=147).
- Long-term graft patency was assessed using postoperative control coronary angiograms obtained after an average of 5.8 years (range: 2 months-20 years).
Main Results:
- Overall graft patency was 60%.
- The 15-year patency rate was significantly higher for DRCA grafts (32% ± 5%) compared to RPDA grafts (19% ± 6%; p=0.001).
- Poor target vessel quality and hypercholesterolemia were identified as factors adversely affecting long-term graft patency.
Conclusions:
- The distal right main coronary artery (DRCA) may be the preferred target vessel for bypass grafting in cases of distal and/or sequential right coronary artery disease.
- Selecting the DRCA over the RPDA is associated with improved long-term saphenous vein graft (SVG) patency.
- Factors such as target vessel quality and hypercholesterolemia significantly impact graft longevity.
Background:
Choosing a good anastomotic site is crucial during surgical revascularization of the right coronary artery (RCA) system. In many instances of distal and/or sequential main trunk disease, either the right posterior descending coronary artery (RPDA) or distal part of the right main coronary artery (DRCA) is preferred as the target vessel. In this article, the saphenous vein graft (SVG) patency is compared between these two main targets in the long term.
Materials And Methods:
Postoperative control coronary angiograms were obtained and assessed from 452 patients undergoing conventional on-pump coronary artery bypass grafting with either a DRCA (n = 305) or a RPDA graft (n = 147) after an average postoperative period of 5.8 ± 4.3 years (range: 2 months-20 years; a total of 2,627 patient-years).
Results:
The overall graft patency was 60%. The 15-year patency rate was better for the DRCA grafts than that for the RPDA grafts (32 ± 5% vs. 19 ± 6%, respectively; p = 0.001), irrespective of target vessel caliber. Other factors adversely influencing the long-term graft patency were poor target vessel quality (p = 0.002) and hypercholesterolemia (p = 0.01). On the other hand, target vessel diameter, diabetes mellitus, hypertension, chronic renal insufficiency, obesity, peripheral arterial disease, or SVG quality were not associated with poor long-term graft patency in these patients having distal-type RCA disease.
Conclusions:
In the presence of distal and/or sequential right coronary disease, DRCA may be the target vessel of choice for bypass grafting, rather than the RPDA, mainly for better long-term SVG patency rates in this location.
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