Graft Selection for the Right Coronary Artery Territory in Off-Pump Coronary Artery Bypass

Abstract

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.

Keywords

coronary artery bypass graft surgery - ischemic heart disease - computed tomography

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