• Min-Seok Kim, Ho Young Hwang, Kwang Ree Cho, and Ki-Bong Kim.
• Department of Thoracic and Cardiovascular Surgery, Armed Forces Yangju Hospital, Yangju, Republic of Korea.
• J. Thorac. Cardiovasc. Surg. 2022 Apr 1; 163 (4): 1333-1343.e1.

ObjectivesWe compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts.MethodsFrom 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or RITA (RITA group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the RITA group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months.ResultsThe early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and RITA groups, 10.3% and 8.4%, respectively; P = .639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and RITA groups (14.1% and 10.2%, respectively; P = .487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P = .470), cardiac mortality-free survival (92.1% vs 90.9%; P = .560), freedom from target vessel revascularization (83.0% vs 91.4%; P = .230), freedom from reintervention (68.8% vs 76.2%; P = .731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P = .364) rates between the matched groups.ConclusionsTotal arterial revascularization using RGEA composite grafts showed comparable results to those using RITA composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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