Abstract 13779: Reappraisal of a 20-Year Experience With the Radial Artery for Coronary Bypass Grafting
This study aimed at evaluating the clinical and angiographic results of radial artery (RA) used in CABG over 20 years. Clinical follow-up (mean=9.2, max=19.8 years) was obtained in 563 patients (632 RA) operated by a single surgeon since 1989. Angiographic follow-up (mean=7.0, max=19.3 years) was performed in 351 patients; 1427 conduits including 629 RA were opacified. At 9.2 years, freedom from overall and cardiac death was 80.3% (452/563) and 92.7% (522/563) respectively. The only predictor of cardiac death was preoperative ejection fraction <40% (survival 81.8% vs 93.4%, p=0.01). Recurrent symptoms were: acute myocardial infarction in 12 (2.1%), recurrent angina in 98 (17.4%) and congestive heart failure in 60 patients (10.6%). Mean ejection fraction assessed by echocardiography was lower compared to preoperative value (55.0% vs 56.7%, p=0.02). Percutaneous interventions were required in 76 patients (13.5%) at 6.5 years: native coronary (n=58), RA (n=19), other grafts (n=7). Reoperation was needed in 13 cases (2.3%) at 6.6 years: valve replacement (n=10) and redo CABG (n=3). At 7.0 years, RA patency was 82.8% (521/629). It was lower than for left internal thoracic artery (ITA) (95.5%, 491/514 p<0.001) and similar to right ITA (87.9%, 51/58 p=0.32), free ITA (80.0%, 44/55 p=0.60) and saphenous graft (81.9%, 140/171 p=0.77). RA patency was lower in patients with recurrent symptoms or stress test/scintigraphy abnormalities than in asymptomatic patients (74.0%, 174/235 vs 88.1% 347/394 p<0.001). RA patency varied with the target artery and was higher for diagonal (93.1%, 95/102) compared to circumflex (82.5%, 274/332 p=0.01) and right coronary (77.6%, 146/188 p<0.001). RA patency tended to be better when used in sequential grafting (91.2%, 52/57 vs 82.0%, 469/572 p=0.08). No impact on RA patency was found for: diabetis (p=0.22), aspirin (p=0.71) or calcium channel blocker treatment (p=0.19). Separating four equal groups at successive follow-up intervals (up to 19.3years), RA patency was: 86.2%, 81.9%, 81.4% and 81.6% at 1.0, 5.4, 8.3 and 13.1years respectively. In conclusion, RA graft for CABG offered excellent clinical results up to 20 years. Beyond the first postoperative year during which some attrition was observed, RA patency was stable with time.
- © 2010 by American Heart Association, Inc.