• J. Thorac. Cardiovasc. Surg. · Oct 2017

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    Is the right internal thoracic artery superior to saphenous vein for grafting the right coronary artery? A propensity score-based analysis.

    • Umberto Benedetto, Massimo Caputo, Mario Gaudino, Giovanni Mariscalco, Alan Bryan, and Gianni D Angelini.
    • Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. Electronic address: umberto.benedetto@bristol.ac.uk.
    • J. Thorac. Cardiovasc. Surg. 2017 Oct 1; 154 (4): 1269-1275.e5.

    ObjectivesAlthough the use of the right internal thoracic artery (RITA) as second arterial conduit to graft the left coronary system consistently has been shown to provide a survival benefit compared with the saphenous vein graft (SVG), the choice of conduit for the right coronary artery (RCA) system remains controversial. We compared long-term (>15 years) survival in patients who underwent RITA-RCA versus SVG-RCA grafting at a single institution.MethodsThe study population consisted of 7223 patients undergoing coronary artery bypass graft surgery. Of them 245 (3.4%) and 6978 (96.6%) received RITA-RCA and SVG-RCA graft, respectively. Propensity score matching and time-segmented Cox regression were used to compare the 2 groups.ResultsSurvival probability at 5, 10, and 15 years were 95.9% (95% confidence interval [CI], 93.4-98.4) versus 96.0% (95% CI, 94.3-97.8), 89.8% (95% CI, 85.9-93.7) versus 88.0% (95% CI, 85.0-91.0) and 82.9% (95% CI, 77.6-88.2) versus 76.3 (95% CI, 72.0-80.5) in the RITA-RCA and SVG-RCA group, respectively. Time-segmented Cox regression showed that during the first 9 years, the 2 strategies were associated with comparable risk of death (hazard ratio, 1.13; 95% confidence interval, 0.67-1.90; P = .65) but beyond 9 years, the RITA-RCA was associated with a significantly lower risk of death (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = .01).ConclusionsRevascularization of the RCA system with the RITA was associated with superior late survival compared with SVG. This supports the view that, the use of RITA to graft the RCA should be encouraged, especially in patients with long life expectancy.Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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