OBJECTIVE:The merits of internal thoracic artery(ITA) grafting for myocardial revascularization of the left coronary system have been established.However,the graft of choice to the right coronary system in patients undergoing bypass grafting has not been determined. We sought to examine,angiographically,the long term results of conduits to the right coronary system associated with the clinical outcome.
METHODS:Among 794 patients undergoing coronary bypass surgery including revascularization of the right coronary system between 1990 and 2003 , postoperative angiographic restudy was conducted on 242 patients beyond 3 years after surgery. Mean age was 62±7.9years,212 patients were male and mean number of distal anastomosis was 2.2. Angiographic restudy was conducted on 222 (SVG:152, GEA:49, RA:5,RITA:16)patients in the midterm (between 3 and 7 years (mean, 5.6 years),and on 93 (SVG:72,GEA:14 RA:1, RITA:6)patients in the long term (between 8 and 13 years(mean, 10.2 years). We determined stenosis more than 75% as occluded graft.
RESULTS:Patency rate of the SVG,GEA,RA and RITA was respectively 83%,87%100%,86% in the midterm. 77%,78%,100%,80% in the long term.The cumulative patency rate of SVG and GEA estimated by the Kaplan-Meier method was respectively 82%,84% at 5 years and 67%,69% at 10 years.The rate of diabetic patients(30% versus 33%),patients with hyperlipidemia(42% versus 50%)was similar in both groups with occluded grafts.
CONCLUSIONS:The mid term and long term patency of the saphenous vein graft(SVG) was equivalent to the gastroepiploic artery(GEA). The SVG can be used effectively for long term in coronary bypass grafting to the right coronary system.