Right gastroepiploic artery versus right internal thoracic artery composite grafts: 10-year patency and long-term outcomes

Objectives: We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts. Methods: From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or RITA (RITA group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the RITA group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months. Results: The early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and RITA groups, 10.3% and 8.4%, respectively; P =.639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and RITA groups (14.1% and 10.2%, respectively; P =.487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P =.470), cardiac mortality-free survival (92.1% vs 90.9%; P =.560), freedom from target vessel revascularization (83.0% vs 91.4%; P =.230), freedom from reintervention (68.8% vs 76.2%; P =.731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P =.364) rates between the matched groups. Conclusions: Total arterial revascularization using RGEA composite grafts showed comparable results to those using RITA composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.