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


CONCLUSIONS
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.
Glineur
David
D
Department of Cardiovascular Medicine and Surgery, University of Louvain Medical School, Brussels, Belgium. david.glineur@clin.ucl.ac.be
Hanet
Claude
C
Poncelet
Alain
A
D'hoore
William
W
Funken
Jean-Christophe
JC
Rubay
Jean
J
Astarci
Parla
P
Lacroix
Valerie
V
Verhelst
Robert
R
Etienne
Pierre Yves
PY
Noirhomme
Philippe
P
El Khoury
Gebrine
G
D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005080:Exercise Test; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency