• Dong Seop Jeong, Yong Han Kim, Young Tak Lee, Su Ryeun Chung, Kiick Sung, Wook Sung Kim, and Pyo Won Park.
• Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• Ann. Thorac. Surg. 2013 Sep 1;96(3):778-85; discussion 785.

BackgroundGraft 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).MethodsBetween 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.ResultsThere 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).ConclusionsArterial 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%.Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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