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Published on: November 19, 2019
Selective coronary vein bypass graft improves outcomes of patients with right coronary artery lesion
Longsheng Dai1, Wenyuan Yu1, Mingxin Gao1
1Department of Cardiac Surgery, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
Insights
Selective coronary vein bypass grafting (SCVBG) is a viable option for severe right coronary artery (RCA) lesions, showing lower perioperative risks than coronary endarterectomy (CE). Long-term outcomes were similar for both SCVBG and CE procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- The efficacy of selective coronary vein bypass grafting (SCVBG) for severe diffuse right coronary artery (RCA) lesions remains unclear, especially for patients unsuitable for coronary endarterectomy (CE).
- Evaluating surgical outcomes for complex RCA disease is crucial for patient management.
Purpose of the Study:
- To compare the perioperative and long-term outcomes of SCVBG versus CE in patients with severe diffuse RCA lesions.
- To identify factors influencing perioperative outcomes in these patient groups.
Main Methods:
- Propensity score matching was used to compare 86 SCVBG patients with 344 CE patients undergoing coronary artery bypass surgery (2015-2018).
- Outcomes assessed included perioperative myocardial infarction (MI), major adverse cardiovascular and cerebrovascular events (MACCE), and long-term survival and MACCE rates.
Main Results:
- SCVBG demonstrated significantly lower rates of perioperative MI (1.5% vs. 5.1%) and MACCE (4.7% vs. 10.2%) compared to CE.
- High graft vascular flow (>100 mL/min) in SCVBG was associated with increased perioperative MACCE, while bilateral internal mammary artery use reduced it.
- No significant differences in long-term survival or MACCE were observed between SCVBG and CE groups.
Conclusions:
- SCVBG is an acceptable surgical intervention for patients with severe diffuse RCA lesions.
- While SCVBG offers reduced perioperative risks, long-term results are comparable to CE.
Background:
The benefits of selective coronary vein bypass grafting (SCVBG) for patients with severe diffuse lesions of the right coronary artery (RCA) who are unsuitable for coronary endarterectomy (CE) are unclear.
Methods:
We recruited patients with diffuse lesions of the RCA undergoing coronary artery bypass surgery between January 2015 and December 2018 and matched SCVBG and CE patients on propensity score (PS). We evaluated the degree of single-stenosis in the RCA, incidence of perioperative myocardial infarction (MI) and major adverse cardiovascular and cerebrovascular events (MACCE), influencing factors of perioperative MACCE, long-term survival rate, and long-term MACCE incidence.
Results:
Overall, 430 patients were enrolled: 344 (80%) underwent CE and 86 (20%) underwent SCVBG (n=78 and n=64, respectively, after PS matching). The incidence of perioperative MI and MACCE were significantly lower in the SCVBG group (5.1% vs. 1.5%, P<0.05; and 10.2% vs. 4.7%, P<0.05). When the vascular flow rate of the graft anastomosed to RCA in the SCVBG group was above 100 mL/min, the incidence of perioperative MACCE significantly increased [odds ratio (OR): 1.94, 95% confidence interval (CI): 1.42-2.03]. Choosing the bilateral internal mammary artery for SCVBG reduced the incidence of perioperative MACCE (OR: 0.82, 95% CI: 0.68-0.92). There was no significant difference in the rates of long-term survival or MACCE between the two groups before or after PS matching (P>0.05).
Conclusions:
SCVBG is an acceptable surgical intervention for patients with severe diffuse RCA lesions.
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