Abstract 19535: Impact of Proximal Anastomotic Site on the Patency of Free Internal Thoracic and Radial Artery in Coronary Artery Bypass Grafting-Y Composite Grafting v.s Aorto-Coronary Bypass
Background: Arterial grafts such as right internal thoracic artery (RITA) and radial artery(RA) has been used as second graft with various configuration. The aim of this study was to compare the arterial graft patency with using either Aorto-coronary (AC) bypass or Y composite grafting anastomosing LITA.
Methods: Between January 1996 and Decmber 2008, 254 patients underwent isolated CABG using free arterial graft in addition to LITA-LAD bypass. Target vessel of free arterial grafts was either diagonal or circumflex branch with significant stenosis. Those patients were divided into 2 groups according to the proximal anastomosis site of free arterial graft. Group AC contained 178 cases with AC bypass with proximal anastomosis to ascending aorta. Group Y contained 76 cases with Y composite grafting with proximal anastomosis to LITA. Patients were evaluatated by coronary angiography (CAG) postoperatively at discharge and by CAG or CT scan during follow up. Graft patency and risk factors influencing patency were statistically investigated.
Results: Total of 154 RA and 24 free RITA were used in Group AC, and 43 RA and 33 free RITA in Group Y. Graft patency at discharge were 95.5% in Group AC and 83.0% in Group Y, respectively (p=0.05). Risk factors for early graft occlusion includes chronic renal failure (p<0.05), and Y composite grafting (p=0.05). Graft patency in 36 months were 95.8% of RITA in group AC, and 74.1% of RITA in group Y, 82.2% of RA in group AC, and 69.8% of RA in group Y, respectively (NS). In multivariate analysis, risk factors for graft occlusion was flow competition in postoperative CAG (p=0.04, Hazard ratio 4.00, 95% confidence interval 1.04–15.2). Conclusion. In our study, the patency of Y composite graft was inferior to that of aortocoronary grafting. RITA showed better patency that RA when used as a free arterial graft, though not statistical significant. Besides graft configuration, flow competition and renal function may play an important role in its patency.
- © 2010 by American Heart Association, Inc.