Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Thorac Surg. 2013 Sep;96(3):778-85; discussion 785. doi: 10.1016/j.athoracsur.2013.04.097. Epub 2013 Jul 16.
Graft selection for the right coronary artery territory remains controversial. The objective of this study was to analyze outcomes from revascularization of the right coronary artery territory using the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), or a saphenous vein graft (SVG).
Between January 2001 and December 2010, 1,434 patients who underwent off-pump coronary artery bypass surgery using the bilateral mammary arteries were enrolled. Propensity score analysis was used to match patients who underwent revascularization of the right coronary artery territory with the RITA in a Y-composite fashion (RITA group, n=292), the RGEA (RGEA group, n=292), and the SVG (SVG group, n=292). Clinical and angiographic data were analyzed.
There were no intergroup differences in terms of in-hospital mortality (0.3% [1 of 292], 0% [0 of 292], and 1% [3 of 292], p=0.332). Freedom from major adverse events including death, stoke, myocardial infarction, and reintervention at 10 years was similar among the three groups (87.8%±3.0% in the RITA group versus 92.4%±1.7% in the RGEA group versus 86.7%±3.4% in the SVG group; p=0.466). A stratified regression analysis showed that use of the saphenous vein was predictive of graft failure (p=0.044, hazard ratio 3.9). Proximal stenosis (<90%) was predictive of graft failure in the arterial groups (p=0.024, hazard ratio 3.1), but not in the SVG group (p=0.112).
Arterial grafts should be considered the first choice for right coronary artery territory revascularization in off-pump coronary artery bypass. However, SVG should be considered when proximal stenosis is less than 90%.
右冠状动脉区域的移植物选择仍然存在争议。本研究的目的是分析使用右内乳动脉（RITA）、右胃网膜动脉（RGEA）或大隐静脉移植物（SVG）对右冠状动脉区域进行血运重建的结果。
2001 年 1 月至 2010 年 12 月，共纳入 1434 例接受非体外循环冠状动脉旁路移植术的患者，使用双侧乳内动脉。采用倾向评分分析将接受右冠状动脉区域血运重建的患者与以 Y 型复合方式接受 RITA（RITA 组，n=292）、RGEA（RGEA 组，n=292）和 SVG（SVG 组，n=292）的患者进行匹配。分析临床和血管造影数据。
三组患者住院死亡率无差异（0.3%[1/292]、0%[0/292]和 1%[3/292]，p=0.332）。10 年时无重大不良事件（死亡、卒、心肌梗死和再介入）的生存率在三组之间相似（RITA 组为 87.8%±3.0%，RGEA 组为 92.4%±1.7%，SVG 组为 86.7%±3.4%；p=0.466）。分层回归分析显示，使用大隐静脉是移植物失败的预测因素（p=0.044，风险比 3.9）。动脉组中近端狭窄（<90%）是移植物失败的预测因素（p=0.024，风险比 3.1），但 SVG 组中不是（p=0.112）。
在非体外循环冠状动脉旁路移植术中，动脉移植物应被视为右冠状动脉区域血运重建的首选。然而，当近端狭窄小于 90%时，应考虑使用 SVG。
