Abstract 14082: Coronary Artery Bypass Grafting Using the Radial Artery: Clinical Outcomes and Patency
Objective: Radial artery (RA) grafts are an attractive second arterial conduit after the left internal thoracic artery (LITA) for coronary artery bypass surgery (CABG). However, long term outcomes and the need for subsequent reintervention have not been defined.
Methods: We performed a retrospective cohort study of our single institution's 16 year experience with 1,851 consecutive patients (average age 58 years, 82% male, 36% diabetic) undergoing primary, isolated CABG with the LITA and RA. Saphenous vein (SV) was used as necessary. Average grafts per patient were 3.8 with 2.4 arterial grafts per patient. Clinical data and results were collected prospectively as part of an audited and state mandated cardiac surgery reporting system. Survival was determined using the Social Security Death Index. Grafts were nonpatent if they had a >50% stenosis, a string sign or were occluded.
Results: Four patients (0.2%) died in hospital and 0.8% had a myocardial infarction, 0.9% a stroke and 0.7% renal failure. Kaplan Meier estimated 1, 5, 10 and 15 year survival was 99%, 96%, 89% and 75%. Of the cohort, 278 symptomatic patients underwent cardiac catheterization at our institution an average of 5.0 + 3.8 years (range 0.1 to 12 years) after CABG. Overall RA (n=415 grafts) patency was 80% and SV (n=364 grafts) patency 47% (p<0.0001). LITA (n=287 grafts including 9 sequential grafts) patency was 85% and RITA (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 intervention and CABG was 85%, 97%, and 99%.
Conclusions: 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.
- © 2011 by American Heart Association, Inc.