Long term effect of saphenous vein versus arterial graft to the right system in left-sided arterial revascularization. - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Mohammad Kakoush ^1,2 Yanai Ben-Gal ^1,2 Tomer Ziv-Baran ^1,2 Nadav Teich ^1,2 Orr Sela ^1,2 Amir Kramer ^1,2 Amit Gordon ^1,2 Rephael Mohr ^1,2 Michal Fartock ^1,2 Dmitry Pevni ^1,2

¹Dept. of Cardiothoracic Surgery, Dept. of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Israel
²Dept. of Epidemiology and Preventive Medicine, Dept. of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Israel

Background: Our aim was to investigate the influence of using various arterial grafts vs saphenous vein grafts to the right coronary system in patients who received bilateral internal thoracic arteries (BITA) to the left side.

Methods: We compared short- and long-term outcomes of all consecutive patients operated in our center during 1996-2011, who received left-sided BITA grafting and either a saphenous vein graft (VG) or an arterial graft (AG) to the right coronary system.

Results: Of 1816 patients, 987 received a saphenous VG and 829 received an AG to the right coronary system: 389 gastroepiploic arteries, 371 internal thoracic arteries and 69 radial artery grafts. Median follow-up was 15.7 ± 0.32 years. For the VG and AG groups, early mortality (1.6% for both groups, p=0.929) and other early adverse outcomes did not differ. Revision for bleeding occurred more frequently in the VG group (2.7% vs. 1.0%, p=0.006). Long-term (up to 20 years) survival was also similar (34.1 +/- 3.4% for VG vs. 36.0 +/-2% for AG, p=0.808). In multivariable analysis, VG to the right coronary artery was not found to be a predictor for inferior survival (hazard ratio: 1.034 95%CI 0.878-1.219, p=0.689). Comparing two propensity matched groups of 429 pairs with a VG or an AG, and accounting for the severity of the right coronary lesion, did not demonstrate any difference in early outcome or late survival between the groups.

Conclusions: Early outcomes and long-term survival were comparable among patients who received left-sided BITA revascularization, between various graft types to the right coronary system.