WHICH IS THE GRAFT OF CHOICE FOR THE RIGHT CORONARY AND POSTERIOR DESCENDING ARTERIES - COMPARISON OF THE RIGHT INTERNAL MAMMARY ARTERY ANDTHE RIGHT GASTROEPIPLOIC ARTERY

Background The graft of choice for the left anterior descending corona ry artery is the left internal mammary artery because of superior long -term patency. However, controversy exists regarding the graft of choi ce for the right coronary artery and for the posterior descending bran ch. Methods and Results Two types of pedicled arterial grafts were use d for the right coronary and the posterior descending arteries in pati ents undergoing coronary bypass surgery between January 1991 and Septe mber 1994. Group A comprised 114 patients with a right internal mammar y artery (RIMA) graft, and group B consisted of 127 patients with an i n situ right gastroepiploic artery (R-GEA) graft. Mean age was 56.9 ye ars in group A and 63.3 years in group B; 7.9% (9 of 114) and 33.9% (4 3 of 127) were diabetics in groups A and B, respectively. Overall mort ality was 2.6% (3 deaths) for group A and 3.9% (5 deaths) for group B (P=NS). However, the prevalence of perioperative myocardial infarction in the right coronary artery distribution was significantly higher fo r group A (5.3%, or 6 of 114) than for group B (0.8%, or 1 of 127; P<. 05), and the reoperation rate for graft failure (from 0 to 12 months a fter surgery) was significantly higher for the RIMA (4.4%, or 5 of 114 ) than for the R-GEA (0%; P<.05). Also, the prevalence of deep sternal wound infection in diabetics was significantly higher in group A (22. 2%, or 2 of 9) than in group B (4.6%, or 2 of 43; P<.05). Conclusions Our preliminary results suggest that the failure rate of the RIMA graf t is significantly higher, especially if used as a pedicled graft to t he posterior descending artery. The risk of sternal wound complication s is greater in diabetics if both internal mammary arteries are used f or grafting. Therefore, the R-GEA graft is preferred in diabetics and whenever the posterior descending artery is the target vessel.