Coronary artery bypass grafts to chronic occluded right coronary arteries

Maleen Fiddicke; Felix Fleissner; Tonita Brunkhorst; Eva M Kühn; Doha Obed; Dietmar Boethig; Issam Ismail; Axel Haverich; Gregor Warnecke; Wiebke Sommer

doi:10.1016/j.xjon.2021.06.007

Coronary artery bypass grafts to chronic occluded right coronary arteries

JTCVS Open. 2021 Jun 9:7:169-179. doi: 10.1016/j.xjon.2021.06.007. eCollection 2021 Sep.

Authors

Affiliations

¹ Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.
² Department of Plastic- and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
³ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.

Abstract

Background: The benefit of revascularizing chronically occluded coronary arteries remains debatable, and available long-term outcome reports are sparse. Current guidelines recommend revascularization of chronically occluded arteries only in patients with myocardial ischemia and/or symptoms associated with angina. We investigated outcome of patients with total chronic occlusion of the right coronary artery (RCA) receiving coronary artery bypass grafting (CABG) surgery with and without revascularization of the RCA.

Methods: We retrospectively analyzed all patients with chronically occluded RCAs receiving CABG with (group 1 = RCA-CABG; n = 487) and without (group 2 = No-RCA-CABG; n = 100) revascularization of the RCA. In total, 587 patients with complete follow-up of a minimum of 6 years were included (92%).

Results: In total, 82% in group 1 versus 86% in group 2 were male (P = .38). European System for Cardiac Operative Risk Evaluation II was comparable between both groups (4.35 ± 7.09% vs 4.80 ± 5.77%, P = .56) with no major differences regarding preoperative characteristics between groups. Patients in group 1 received 3.24 ± 0.79 distal anastomoses, whereas group 2 received 2.45 ± 0.83 distal anastomoses (P < .001). Although in-hospital mortality was comparable (2.9% in group 1 vs 5.0% in group 2, P = .27), long-term survival was significantly better in group 1 (P = .002). No difference in the incidence of further major adverse cardiac and cerebrovascular events was found.

Conclusions: Patients with a chronically occluded RCA undergoing CABG who did not receive an RCA graft showed a significantly reduced long-term survival. Given the herein presented data, revascularization of chronically occluded right arteries during CABG should be recommended whenever technically feasible.

Keywords: CABG; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CR, complete revascularization; CTO, chronic total occlusion; EuroSCORE II, European System for Cardiac Operative Risk Evaluation II; IQR, interquartile range; IR, incomplete revascularization; MACCE, major adverse cardiac and cerebrovascular events; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCA, right coronary artery; chronic occluded coronary arteries; coronary artery bypass grafting; coronary artery disease.