Graft Patency Analysis of the Right Coronary Artery System

Study Overview
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Brief Summary
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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 Laboratories Quantitative coronary analysis (preoperative) Major adverse cardiac and cerebrovascular event coronary CT (coronary angiography if needed) at discharge, 1, 5, 10 years postoperatively Echocardiogram 5. Cardiac enzyme

Detailed Description
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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.

Official Title
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Graft Patency of the Right Coronary Artery System in OPCAB: Saphenous Vein Graft Versus Right Gastroepiploic Artery

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Procedure: A right gastroepiploic artery in situ grafting
* Procedure: A saphenous vein grafting


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| RGEA group<br>A right gastroepiploic artery in situ grafting in the right coronary artery system during OPCAB | Procedure: A right gastroepiploic artery in situ grafting<br>* A right gastroepiploic artery in situ grafting in the right coronary artery system during OPCAB<br>|
| SVG group<br>A saphenous vein grafting in the right coronary artery system during OPCAB | Procedure: A saphenous vein grafting<br>* A saphenous vein grafting in the right coronary artery system during OPCAB<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All cause mortality |  | one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Graft occlusion | Coronary CT follow up at discharge, 1, 5 and 10 years postoperatively | one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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OPCAB