In situ gastroepiploic artery versus I-composite right internal thoracic artery radial artery for severe right coronary artery stenosis in off-pump coronary artery bypass grafting

TL;DR

This study compares two grafting techniques for heart surgery and finds the gastroepiploic artery may offer better long-term outcomes.

Contribution

The study evaluates the gastroepiploic artery as a graft option for severe right coronary artery stenosis in off-pump bypass surgery.

Findings

The gastroepiploic artery group had lower long-term major adverse cardiac events.

Short-term outcomes were similar between the two grafting techniques.

Peripheral arterial disease history was a significant risk factor for mortality.

Abstract

This study compared the I-composite graft comprising the right internal thoracic artery and radial artery with the gastroepiploic artery in off-pump coronary artery bypass grafting for severe right coronary artery stenosis.

This study included 78 and 141 patients who underwent right internal thoracic artery-radial artery and gastroepiploic artery grafting, respectively, for off-pump coronary artery bypass grafting between April 2011 and June 2024. Propensity score matching was conducted, and postoperative outpatient follow-up was performed.

Propensity score matching resulted in 65 patients in each group. Preoperative characteristics, operative time, and the number of arterial revascularizations and distal anastomoses did not differ significantly between the groups. However, more graft conduits were used in the right internal thoracic artery-radial artery group. Short-term postoperative outcomes were similar, except for a significantly higher early extubation rate in the right internal thoracic artery-radial artery group. During a median follow-up of 5.0 years, overall survival did not differ significantly between the groups. However, the gastroepiploic artery group had a significantly lower long-term freedom from major adverse cardiac and cerebrovascular events, particularly heart failure requiring hospitalization. Multivariate analysis identified a history of peripheral arterial disease as a significant risk factor for overall mortality, whereas the type of right coronary artery graft was not.

Using the gastroepiploic artery as a direct conduit for severe right coronary artery stenosis appears to be a promising option when selecting an arterial graft, particularly in improving major adverse cardiac or cerebrovascular events-free survival.

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