Coronary Artery Disease
Conditions
Keywords
OPCAB
Brief summary
The ideal grafts for the right coronary artery system in coronary artery bypass surgery remain controversial. The objective of this study is to compare the long-term patency of a right gastroepiploic artery and a saphenous vein graft used for revascularization of the right coronary artery system in off pump coronary artery bypass surgery and to analyze the long-term clinical outcomes. Total 224 patients will be enrolled according to the randomization protocol. Check list 1. Laboratories 2. Quantitative coronary analysis (preoperative) 3. Major adverse cardiac and cerebrovascular event 4. coronary CT (coronary angiography if needed) at discharge, 1, 5, 10 years postoperatively 5. Echocardiogram 5\. Cardiac enzyme
Detailed description
The ideal bypass conduit for the right coronary artery remains a subject of intense controversy. A variety of grafts and configurations are used: the right gastroepiploic artery,the right internal thoracic artery in situ or in a Y-graft configuration,the free radial artery implanted into the aorta or the left internal thoracic artery, and the saphenous vein graft. The influence of the type of graft to the right coronary artery system on clinical results remains poorly documented, and the complementary conduit of choice to this system has yet to be determined. No superior long-term patency rate for any of these grafts to the RCA has been clearly established. We have used a saphenous vein and a right gastroepiploic artery for the right coronary artery system.
Interventions
PROCEDUREA right gastroepiploic artery in situ grafting
A right gastroepiploic artery in situ grafting in the right coronary artery system during OPCAB
PROCEDUREA saphenous vein grafting
A saphenous vein grafting in the right coronary artery system during OPCAB
Sponsors
Samsung Medical Center
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Angiographic evidence of severe coronary stenosis on the right coronary territory * Elective surgery * Isolated off pump CABG * Age \< 75 years and life expectancy \> 5 years * Preoperative RGEA diameter \> 1.5mm * Normal left ventricular function
Exclusion criteria
* History of upper abdomen surgery * History of upper GI bleeding * Active gastric or duodenal ulcer * Body mass index \> 35kg/m2 * Redo surgery * Presence of varicose vein * Contraindication for CABG such as malignancy or liver cirrhosis * Other configuration than RGEA to RCA territory or SVG to RCA territory
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| All cause mortality | one year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Graft occlusion | one year | Coronary CT follow up at discharge, 1, 5 and 10 years postoperatively |
Countries
South Korea
Outcome results
None listed