Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention.
ABSTRACT Radial artery (RA) grafts are an attractive second arterial conduit after the left internal thoracic artery (LITA) for coronary artery bypass graft (CABG) surgery. However, long-term outcomes and the need for subsequent reintervention have not been defined.
We performed a retrospective cohort study of our single institution's 16-year experience with 1851 consecutive patients (average age, 58 years; 82% men, 36% diabetic) undergoing primary, isolated CABG with the LITA, RA, and saphenous vein as needed. Average grafts per patient were 3.8, with 2.4 arterial grafts per patient. Survival was determined using the Social Security Death Index. Grafts were nonpatent if they had a >50% stenosis, a string sign, or were occluded. Five patients (0.3%) died in hospital and 0.8% had a myocardial infarction, 1.1% a stroke, and 0.6% renal failure. Kaplan-Meier-estimated 1-, 5-, 10-, and 15-year survival was 99%, 96%, 89%, and 75%, respectively. Of the cohort, 278 symptomatic patients underwent cardiac catheterization at our institution an average of 5.0±3.8 years (range, 0.1-12 years) after CABG. Overall RA (n=420 grafts) patency was 82% and SV (n=364 grafts) patency, 47% (P<0.0001). LITA (n=287 grafts including 9 sequential grafts) patency was 85% and right internal thoracic artery (n=15 grafts) patency was 80% (P=0.6). RA patency was not different from LITA patency (P=0.3). Overall freedom from catheterization, percutaneous coronary intervention, and CABG was 85%, 97%, and 99%, respectively.
RA grafting is a highly effective revascularization strategy providing excellent short and long-term outcomes with very low rates of reintervention. RA patency is similar to LITA patency and is much better than SV patency. RA grafting should be more widely utilized in patients undergoing CABG.
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ABSTRACT: Abstract OBJECTIVE: Additional arterial grafts such as the right internal mammary artery (RIMA) or the radial artery (RA) have been proposed to improve long term outcomes in coronary artery bypass grafting (CABG). RA is largely preferred over RIMA as it is less technically demanding and there is a perception that bilateral IMA usage increases the risk of sternal wound complications. However, there is a paucity of direct comparison of the two conduits to guide surgeons to choose the best second arterial conduit for CABG. METHODS: A propensity score adjusted analysis of patients undergoing multiple arterial grafting with RIMA (n=747) and RA (n=779) during the study period (2001-2013) was conducted to investigate the impact of the two strategies on early and late outcomes. RESULTS: RIMA did not increase the incidence of postoperative complications including deep sternal wound infection (P=.8). Compared to the RIMA, the RA was associated with an increased risk for late mortality (Hazard Ratio [HR] 1.9; 95% confidence interval (CI) 1.2-3.1; P=.008) and repeat revascularization (HR 1.5; 95% CI 1.0-2.2; P=.044). A trend towards an extra risk for late mortality from RA over RIMA was observed among diabetic (HR 3.3; 95%CI 1.1-9.7) and obese patients (HR 2.1; 95%CI .8-5.46). CONCLUSIONS: RIMA as a second conduit did not increase the operative risk including sternal wound complications and improved long term outcomes including overall survival when compared to RA. This advantage was stronger among diabetic and obese patients. These findings strongly support RIMA as the first choice second arterial conduit in CABG. Further randomized studies with angiographic control and long-term follow-up are needed to address this issue. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved. KEYWORDS: Coronary artery bypass grafting; internal mammary artery; multiple arterial grafting; propensity score analysis; radial artery PMID: 25153938 [PubMed - as supplied by publisher]International Journal of Surgery 08/2014; · 1.65 Impact Factor
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ABSTRACT: Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revascularization of diabetic patients, we compared the outcomes for RA and RITA grafts to the circumflex coronary.The Annals of Thoracic Surgery 05/2014; · 3.63 Impact Factor
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ABSTRACT: The burden of diseases associated with diabetes mel-litus is dramatic: adults with diabetes mellitus are 2 to 4 times more likely to have cardiovascular diseases than those without it, and at least 65% will die be-cause of diabetes complications. The revasculariza-tion strategy in these types of patients included per-cutaneous coronary interventions with bare metal stents or medicated stents and surgical coronary ar-tery bypass grafting (CABG), but it is well known that in the diabetic patient with two or more vessel disease, the surgical strategy allows the best mid-and long-term results. Moreover, benefits of CABG surgery are limited by life expectancy of the most common type of graft, the saphenous vein (SV). Nearly 40 years after the introduction of bypass surgery, the rate of vein graft failure remains at high levels. Several arterial conduits had been studied as alternative conduits to SV: the Right Internal Thoracic Artery (RITA), the Radial Artery (RA), the Gastroepiploic Artery (GEA) and the Inferior Epigastric Artery (IEA), 40 years ago. The aim of our article is to review the scientific literature of the past 15 years to answer this question: are we ready to treat the diabetic patient, with a com-pletely arterial revascularization, avoiding the use of the great saphenous vein grafts?World Journal of Cardiovascular Diseases 10/2013; 3.