Equivalency of Right Internal Thoracic Artery and Right Gastroepiploic Artery Composite Grafts: Five-Year Outcomes

Background We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. Methods Of 443 patients who underwent off-pump coronary revascularization exclusively using arterial Y-composite grafts, the RITA (n = 114) or RGEA (n = 329) was anastomosed to the side of the in situ left internal thoracic artery. A propensity score-matched analysis was used to match patients using the RITA (RITA group, n = 105) with patients using the RGEA (RGEA group, n = 105). Five-year angiographic patency rates and long-term clinical outcomes were compared. Results There were no differences in early mortality and postoperative complication rates between the RITA and RGEA groups. Five-year postoperative angiography showed no significant differences in overall graft patency (95.0% versus 95.1%; p = 0.895) and second-limb conduit patency (RITA versus RGEA, 93.4% versus 92.1%; p = 0.704) rates between the two groups. Propensity score-adjusted multivariable analysis revealed that previous history of percutaneous coronary intervention was the only significant risk factor for second-limb conduit occlusion at 5 years postoperatively ( p = 0.003). No differences in overall survival ( p = 0.703) and freedom from cardiac death ( p = 0.968) rates were observed between the two groups. Reintervention-free survival ( p = 0.236) and major adverse cardiac and cerebrovascular event-free survival ( p = 0.704) rates were also similar between the two groups. Conclusions Total arterial revascularization using RITA and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes.