title: In off-pump surgery, skeletonized gastroepiploic artery is superior to saphenous vein in patients with bilateral internal thoracic arterial grafts.
abstract: BACKGROUND
  When the bilateral internal thoracic arteries are grafted to the left coronary arteries, it remains controversial whether the better conduit is provided by grafting the saphenous vein graft (SVG) or the gastroepiploic artery (GEA) to the right coronary artery territory. From the beginning of the present study, we consistently used the GEA in a skeletonized fashion using ultrasound scissors.
  
  
  METHODS
  From January 2002 to December 2009, 320 consecutive patients with triple-vessel disease underwent in situ bilateral internal thoracic artery grafting to the left coronary arteries. Among the 320 patients, of whom 229 underwent GEA grafting to the right coronary artery and 91 SVG grafting, 85 propensity score-matched pairs were identified (C statistic, 0.68 [p < 0.001]).
  
  
  RESULTS
  The mean follow-up duration was 5.1 ± 2.2 years. Seven-year freedom from death from all causes was 96.0% in the GEA group and 82.2% in the SVG group (p = 0.03); the rate of freedom from cardiac events (cardiac death, myocardial infarction, angina pectoris, repeat intervention, and heart failure) was 89.3% in the GEA group and 77.5% in the SVG group (p = 0.048). Multivariate Cox proportional hazard regression analysis showed that SVG use (without GEA) (p = 0.04; hazard ratio, 0.31; 95% confidence interval, 0.11 to 0.94) and smoking history (p = 0.02; hazard ratio, 0.22; 95% confidence interval, 0.07 to 0.81) were independent predictors of late cardiac event.
  
  
  CONCLUSIONS
  Skeletonized GEA grafting to the right coronary artery system is better than SVG grafting in patients with left-sided bilateral internal thoracic arterial grafts.
authors: Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan. suzukit@belle.shiga-med.ac.jp
authors: Tomoaki
authors: T
authors: Suzuki
authors: Tohru
authors: T
authors: Asai
authors: Keiji
authors: K
authors: Matsubayashi
authors: Atsushi
authors: A
authors: Kambara
authors: Takeshi
authors: T
authors: Kinoshita
authors: Noriyuki
authors: N
authors: Takashima
authors: So
authors: S
authors: Hosoba
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014656:Vascular Surgical Procedures / Q000379:methods