title: Revascularization of the right coronary artery: grafting or percutaneous coronary intervention?
abstract: BACKGROUND
  The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy-hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical-and if the latter, the best conduit.
  
  
  METHODS
  We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention. A review of the English language literature determined the variables for each strategy. All possible outcomes of each strategy were analyzed to determine the baseline strategy yielding the highest expected effectiveness. Sensitivity analysis determined the most relevant elements in the model and indicated threshold values.
  
  
  RESULTS
  Arterial grafting of the RCA led to the highest expected effectiveness, respectively 6% and 7% higher than that of percutaneous coronary intervention and the saphenous graft procedure. Of the arteries available-the radial, right gastroepiploic, and right internal thoracic artery-the most effective was the right internal thoracic artery, pedicled for the proximal part of the RCA and free connected as a Y or a T to the pedicled left internal thoracic artery for the distal part of the RCA. Sensitivity analysis showed surgery to be the appropriate strategy when the expected 1-year patency rate of the arterial graft exceeded 80%.
  
  
  CONCLUSIONS
  This analysis shows arterial grafting of the RCA to have better outcomes than percutaneous coronary intervention, and the right internal thoracic artery to be the best conduit.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz Hospital, Besançon, France. pierre-emmanuel.falcoz@wanadoo.fr
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.forename: Lucian
authors.initials: L
authors.lastname: Stoica
authors.forename: Djamel
authors.initials: D
authors.lastname: Kaili
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
authors.forename: Joseph-Philippe
authors.initials: JP
authors.lastname: Etievent
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged