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J Thorac Cardiovasc Surg 2008;136:482-488
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: A prospective randomized clinical, functional, and angiographic midterm evaluation

Department of Cardiovascular Medicine and Surgery, University of Louvain Medical School, Brussels, Belgium

Received for publication November 2, 2007; revisions received December 26, 2007; accepted for publication January 7, 2008.

^_* Address for reprints: David Glineur, MD, Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc, UCL 90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. (Email: david.glineur{at}clin.ucl.ac.be).

Objective: Despite its theoretic advantage over saphenous vein grafts, the right gastroepiploic artery graft has not been accepted as the ideal conduit to revascularize the right coronary artery. We therefore prospectively randomized these 2 grafts types to compare their clinical, functional, and angiographic evolution at 6 months and 3 years.

Methods: From 2003 to 2006, 1397 consecutive patients underwent isolated revascularization at the University of Louvain Medical School. Of this group, 370 patients met the inclusion criteria for randomization and 66% of those were randomized. The right coronary artery was revascularized with saphenous vein grafts in 116 patients and with right gastroepiploic arteries in 122 patients. All patients underwent angiographic control 6 months postoperatively. The end points were major adverse cerebrocardiovascular events and proportion of grafts patent or functional at follow-up angiography.

Results: There were no significant differences between the 2 groups in terms of hospital events. At follow-up there was no significant difference in major adverse cerebrocardiovascular events between the 2 groups. At the 6-month angiographic follow-up, 91% of the anastomoses in the right gastroepiploic artery group and 95% of the anastomoses in the saphenous vein graft group were controlled patent (P = .92). In nonoccluded right coronary arteries, the proportion of patent grafts was significantly lower and the proportion of nonfunctioning grafts was significantly higher in the right gastroepiploic artery group than in the saphenous vein graft group.

Conclusion: There were no significant patency or major adverse cerebrocardiovascular events rate differences between the 2 groups; however, the number of functional grafts was significantly higher in the saphenous vein graft group. Careful selection of the coronary target is mandatory to obtain good results in gastroepiploic artery grafting.

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