Abstract 19172: Long-Term Patency of Sequential Radial Artery Grafting to the Left Circumflex and Right Coronary Arteries: A 10-Year Angiographic Follow-up of Competitive Flow
Objective: It has been still controversial whether sequential radial artery(RA) grafting is reliable, especially for the left circumflex(LCX) and right coronary artery(RCA) regions. We examined the 10-year clinical and angiographic outcomes in total arterial complete revascularization to delineate efficacy of sequential RA grafting and the effect of competitive flow.
Methods: We reviewed clinical records and angiograms of 602 patients with 2518 bypass grafts (4.2±0.9 per patient) who underwent off-pump CABG for 3-vessel vascular regions using the internal thoracic artery(ITA) and RA without aortic manipulation and following early postoperative angiography since April 2000. Distal anastomoses of RAG were 1751, and 1628(93%) were sequential anastomoses. In early angiography, graft flow was graded as antegrade, competitive, and no flow(=occlusion). Late angiography was performed for 389 bypass grafts in 98 patients for clinical reasons. The follow-up period was 54±31 months.
Results: The early patency rate was 98.0% (2468/2518). For RAG, the early patency rate was 97.7%(1710/1751), while competitive flow was found in 5.2% (131/2518). The actuarial patency rate of RA with antegrade flow were significantly higher than that of RA with competitive flow (85.0% at 5 yrs vs. 31.3% at 5 yrs, p<0001). The actuarial patency rate of RA for targets with 51–75% stenosis was 59.2% at 5 yrs, whereas that of RA for the targets with 91–100% was 92.4% (p<.0001). There was no significant difference in the actuarial patency rate of sequential RAG and that of non-sequential RA (74.2% at 5 yrs vs. 71.2% at 5 yrs, p=0.35). The actuarial patency rate of RA for small targets (internal diameter<1.5mm) was similar to that of RA for large targets (>1.5mm) (69.5% vs. 70.4% at 5 yrs, p=0.88).
Conclusions: Sequential grafting did not affect patency of RAG. Graft flow played a definitive role. RA would provide advantages as the arterial material, such as efficacy for small targets and long-term patency, and is considered reliable for LCX and RCA, as far as competitive flow is avoided.
- © 2010 by American Heart Association, Inc.