Abstract
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.
Keywords
coronary artery bypass grafts surgery - CABG - atherosclerosis - restenosis
