title: Surgical decision making for revascularization of chronically occluded right coronary artery.
abstract: OBJECTIVE
  Chronic totally occluded right coronary artery (CTO-RCA) often poses a problem in decision making for/against bypass grafting due to the lack of standardized indication criteria. The aim of the study was to investigate whether qualitative angiograms can be useful in decision making for/against surgical revascularization of CTO-RCA.
  
  
  METHODS
  A retrospective cohort study was conducted with 69 patients who underwent elective CABG procedure, including single graft to the RCA. The distal run-off of the bypassed RCA was measured intraoperatively using the ultrasonic transit-time method. As a primary endpoint of the study, the flow values were analysed in regard to diameter of the recipient artery. As a secondary endpoint, the correlations between the regional and global LV function, Rentrop grading, type of collateral pathway, number of donor sources, comorbidity, and the graft flow and the diameter of the recipient artery were investigated using uni- and multi-variate regression analyses.
  
  
  RESULTS
  In general, the flow values correlated significantly with the diameter of the recipient artery. Significantly lower flow (p < 0.0001) and diameter values (p < 0.05) were found in hypo/akinetic and infarcted area reflecting functionality of the CTO-RCA territory.
  
  
  CONCLUSIONS
  The qualitative angiograms combined with regional wall motion studies can be useful in decision making for revascularization of CTO-RCA. Revascularization of akinetic/infarcted CTO-RCA territory is associated with lower graft flows even in patients presented with high Rentrop class and high degree of collaterality, suggesting necessity of viability tests prior to bypass surgery.
authors: Clinic of Cardiovascular Surgery, University of Duesseldorf, Moorenstrasse 5, 40255, Duesseldorf, Germany. Borowski@med.uni-duesseldorf.de.
authors: Andreas
authors: http://orcid.org/0000-0002-2405-632X
authors: A
authors: Borowski
authors: Clinic of Cardiovascular Surgery, University of Duesseldorf, Moorenstrasse 5, 40255, Duesseldorf, Germany.
authors: Erhard
authors: E
authors: Godehardt
authors: Clinic of Cardiovascular Surgery, University of Duesseldorf, Moorenstrasse 5, 40255, Duesseldorf, Germany.
authors: Hannan
authors: H
authors: Dalyanoglu
mesh_terms: D000368:Aged; D002908:Chronic Disease; D000066491:Clinical Decision-Making; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Chronic total occlusion; Coronary artery disease; Coronary bypass surgery