Off-pump right coronary artery bypass with saphaneous vein or in-situ right internal thoracic artery

Abstract

BACKGROUND: The ideal conduit for the right coronary artery (RCA) is yet to be determined. The purpose of this study was to compare the clinical results between the right internal thoracic artery (RITA) in situ with free saphenous vein (SV) graft for RCA in off-pump coronary artery bypass graft surgery (OPCABG).

METHODS: Three hundred and fifty-eight patients who underwent isolated OPCABG with RCA anastomosis either by RITA in situ (n = 199) or free SV graft (n = 159) were included. We evaluated the graft patency and the incidence of RCA reintervention considering the degree of native RCA stenosis. The follow-up rate was 97.8%, and the mean follow-up duration was 57.6 months.

RESULTS: The overall mortality and the incidence of major cardiac and cerebrovascular event showed no difference between the two groups (p = 0.495 and p = 0.338, respectively). The 5-year freedom from graft occlusion rate was 87.4% +/- 3.2% in the RITA group and 94.3% +/- 2.0% in the SV group (p = 0.011), with a statistically significant difference only in the moderate stenosis (< 75%) group (p = 0.020). The 5-year freedom from RCA reintervention rate was 95.7% +/- 1.6% in the RITA group and 99.3% +/- 0.7% in the SV group (p = 0.055).

CONCLUSIONS: Both RITA and SV showed favorable graft patency for the RCA system in OPCABG. The SV graft showed better patency in patients with moderate stenosis of RCA compared with RITA in situ. A longer follow-up period is necessary to clarify our current results