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Pierre-Emmanuel Falcoz
Sidney Chocron
Lucian Stoica
Djamel Kaili
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Right arrow Coronary disease

Ann Thorac Surg 2005;79:1232-1239
© 2005 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Revascularization of the Right Coronary Artery: Grafting or Percutaneous Coronary Intervention?

Pierre-Emmanuel Falcoz, MDa,*, Sidney Chocron, MD, PhDa, Christine Binquet, MD, PhDb, Lucian Stoica, MDa, Djamel Kaili, MDa, Catherine Quantin, MD, PhDb, Joseph-Philippe Etievent, MDa

a Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz Hospital, Besançon, France
b Department of Biostatistics, University Hospital, Dijon, France

Accepted for publication September 24, 2004.

* Address reprint requests to Dr Falcoz, Department of Thoracic and Cardiovascular Surgery, Hôpital Jean-Minjoz, Boulevard Fleming, 25000 Besançon, France (E-mail: pierre-emmanuel.falcoz{at}wanadoo.fr).

BACKGROUND: The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy—hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical—and if the latter, the best conduit.

METHODS: We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention. A review of the English language literature determined the variables for each strategy. All possible outcomes of each strategy were analyzed to determine the baseline strategy yielding the highest expected effectiveness. Sensitivity analysis determined the most relevant elements in the model and indicated threshold values.

RESULTS: Arterial grafting of the RCA led to the highest expected effectiveness, respectively 6% and 7% higher than that of percutaneous coronary intervention and the saphenous graft procedure. Of the arteries available—the radial, right gastroepiploic, and right internal thoracic artery—the most effective was the right internal thoracic artery, pedicled for the proximal part of the RCA and free connected as a Y or a T to the pedicled left internal thoracic artery for the distal part of the RCA. Sensitivity analysis showed surgery to be the appropriate strategy when the expected 1-year patency rate of the arterial graft exceeded 80%.

CONCLUSIONS: This analysis shows arterial grafting of the RCA to have better outcomes than percutaneous coronary intervention, and the right internal thoracic artery to be the best conduit.






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