Arterial versus venous graft debate continues

Researchers say that there is no significant reduction in angiographic graft failure with arterial grafts compared with saphenous vein (SV) grafts in revascularization of the right coronary system (RCA).

However, the radial artery (RA) to the proximal RCA is an exception, report Thanos Athanisiou (Imperial College London, UK) and co-authors. They propose that future research focuses on clinical and patient-reported endpoints to identify any benefits of RCA arterial revascularization.

The systematic review of 29 studies revealed that there was no significant difference in early failure of RA or right gastroepiploic artery grafts when compared with SV grafts.

However, mid-term (1-5 years) odds ratios based on observational study data demonstrated an increased graft failure rate with the right gastroepiploic artery and right internal thoracic artery compared with SV grafts, at odds ratios of 2.76 and 2.07, respectively, although the association for the right internal thoracic artery did not achieve statistical significance.

No significant difference was observed in late (>5 years) graft failure for RA compared with SV grafts. However, simplified statistical pooling revealed a significantly lower graft failure rate with RA grafts to the proximal RCA when compared with SV grafts.

"In summary, SV grafting remains a safe conduit option for the RCA in general with comparable outcomes to arterial grafts," remark Athanisiou and team in Heart.

They explain that until now, the optimal conduit choice in revascularization of the RCA was uncertain.

"Right gastroepiploic grafts are seen to perform less well than SV over time, whereas in some analyses with specific relation to the proximal RCA radial grafts show lower graft failure rates," add the authors.

"This warrants further investigation, as it has implications for both patients and healthcare providers and may even reduce the financial burden of long-term graft failure angina recurrence, readmission and need for reintervention caused by occluded conduits," they conclude.

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