Graft selection for the right coronary artery territory in off-pump coronary artery bypass.

Background: The ideal bypass conduit in a right coronary artery (RCA) system remains controversial.
Methods: We analyzed 121 patients who underwent off-pump coronary artery bypass with internal thoracic arteries for the left coronary artery system and either in situ a right gastroepiploic artery (RGEA; n = 66) or a saphenous vein graft (SVG; n = 55) for the RCA system were enrolled. Follow-up coronary computed tomographic angiographic data were reviewed.
Results: The RGEA group showed higher graft patency at 5 years, especially in high grade stenosis (≥ 80%; p = 0.009). In the SVG group, no difference was found between high grade stenosis and low grade stenosis. Freedom from adverse cardiac events at 5 years was higher in the RGEA group (p = 0.006). On multivariate analysis, low grade stenosis of RCA was predictive of graft failure (p = 0.029, hazard ratio = 10.9).
Conclusions: In high grade stenosis of RCA, the RGEA group showed higher patency rate. The patency rate of SVG was not dependent on the degree of stenosis of RCA.
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