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Radial Artery as a Coronary Artery Bypass Conduit: 20-Year Results.

Published on Aug 1, 2016in Journal of the American College of Cardiology18.639
· DOI :10.1016/j.jacc.2016.05.062
Mario Gaudino30
Estimated H-index: 30
(Cornell University),
Paolo Tondi22
Estimated H-index: 22
(CUA: The Catholic University of America)
+ 8 AuthorsMassimo Massetti1
Estimated H-index: 1
(Cornell University)
Sources
Abstract
Abstract Background There is a lack of evidence for the choice of the second conduit in coronary surgery. The radial artery (RA) is a possible option, but few data on very-long-term outcomes exist. Objectives This study describes 20-year results of RA grafts used for coronary artery bypass grafting and the effects of RA removal on forearm circulation. Methods We report the results of the prospective 20-year follow-up of the first 100 consecutive patients who received the RA as a coronary bypass conduit at our institution. Results Follow-up was 100% complete. There were 64 deaths, 23 (35.9%) from cardiovascular causes. Kaplan-Meier 20-year survival was 31%. Of the 36 survivors, 33 (91.6%) underwent RA graft control at a mean of 19.0 ± 2.5 years after surgery. The RA was found to be patent in 24 cases (84.8% patency). In the overall population, probability of graft failure at 20 years was 19.0 ± 0.2% for the left internal thoracic artery (ITA), 25.0 ± 0.2% for the RA, and 55.0 ± 0.2% for the saphenous vein (p = 0.002 for RA vs. saphenous vein, 0.11 for RA vs. ITA, and p 90%, but not location of distal anastomosis, significantly influenced long-term RA graft patency. No patients reported hand or forearm symptoms. The ulnar artery diameter was increased in the operated arm (2.44 ± 0.43 mm vs. 2.01 ± 0.47 mm; p  Conclusions The 20-year patency rate of RA grafts is good, and not inferior to the ITA, especially when the conduit is used to graft a vessel with >90% stenosis. RA harvesting does not lead to hand or forearm symptoms, even at a very-long-term follow-up.
  • References (13)
  • Citations (27)
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References13
Newest
#1Mario Gaudino (CUA: The Catholic University of America)H-Index: 30
#2David P. Taggart (John Radcliffe Hospital)H-Index: 52
Last. Massimo Massetti (CUA: The Catholic University of America)H-Index: 27
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Coronary artery bypass grafting is the most common cardiac surgery operation performed worldwide. It is the most effective revascularization method for several categories of patients affected by coronary artery disease. Although coronary artery bypass grafting has been performed for more than 40 years, no detailed guidelines on the choice of coronary artery bypass grafting conduits have been published and the choice of the revascularization strategy remains more a matter of art than of science. ...
36 CitationsSource
#1Mario Gaudino (CUA: The Catholic University of America)H-Index: 30
#2Filippo Crea (CUA: The Catholic University of America)H-Index: 73
Last. Massimo Massetti (CUA: The Catholic University of America)H-Index: 27
view all 4 authors...
We reviewed the published literature on the clinical and angiographic outcome of radial artery (RA) grafts and on the comparison between the RA and the other conduits used in coronary operations. The RA is a better graft than the saphenous vein and comparable to the right internal thoracic artery (RITA); moreover, the RA seems a better choice than the RITA in patients at risk of sternal or pulmonary complications. We conclude that the RA should be preferred to the saphenous vein and considered a...
14 CitationsSource
126k Citations
#1Andrew W. ElBardissi (Brigham and Women's Hospital)H-Index: 15
#2Sary F. Aranki (Brigham and Women's Hospital)H-Index: 44
Last. James S. Gammie (UMB: University of Maryland, Baltimore)H-Index: 46
view all 6 authors...
Objective Coronary artery bypass grafting (CABG) is the operation most commonly performed by cardiac surgeons. There are few contemporary data examining evolving patient characteristics and surgical outcomes of isolated CABG. We used the Society of Thoracic Surgeons adult cardiac surgery database to characterize trends in patient characteristics and outcomes after CABG over the past decade. Methods From 2000 to 2009, 1,497,254 patients underwent isolated primary CABG at Society of Thoracic Surge...
260 CitationsSource
OBJECTIVE: This study aimed at evaluating the clinical and angiographic results of the radial artery (RA) used as a coronary bypass graft over 20 years. METHODS: Clinical follow-up was obtained in 563 patients at 9.2 years. Angiographic follow-up was obtained in 351 patients with opacification of 1427 conduits, including 629 RA at 7.0 years. RESULTS: At 9.2 years, freedom from overall and cardiovascular death was 80.3% and 92.7%, respectively. Symptoms were: acute myocardial infarction: 2.1% (n=...
43 CitationsSource
#1James Tatoulis (University of Melbourne)H-Index: 29
#2Brian F. Buxton (University of Melbourne)H-Index: 44
Last. Rochelle Wynne (Royal Melbourne Hospital)H-Index: 11
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Background To avoid late vein graft atheroma and failure, we have used arterial grafts extensively in coronary operations. The radial artery (RA) is the conduit of second choice. This study determined the long-term patency of the RA as a coronary graft. Methods Two independent observers evaluated 1108 consecutive postoperative RA conduit angiograms performed between January 1997 and June 2007 for cardiac symptoms. Mean time to postoperative angiography was 48.3 months (range, 1 to 132 months). A...
131 CitationsSource
#1Mario GaudinoH-Index: 30
#2Michele Serricchio (CUA: The Catholic University of America)H-Index: 21
Last. Gianfederico PossatiH-Index: 30
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Background Only scant information is available on the chronic consequences of radial artery removal for coronary artery bypass surgery on forearm circulation. Methods Twenty-five patients submitted to radial artery removal for coronary artery bypass were submitted to serial Doppler echocardiographic evaluation of the flow and morphology of the forearm arteries. Results The peak systolic velocity of the ulnar artery of the operated side was significantly higher than that of the control site. The ...
32 CitationsSource
#1Mario Gaudino (CUA: The Catholic University of America)H-Index: 30
#2Nicola Luciani (CUA: The Catholic University of America)H-Index: 23
Last. Gianfederico Possati (CUA: The Catholic University of America)H-Index: 30
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Background Chronic calcium channel blocker therapy has traditionally been considered necessary in patients carrying a radial artery graft, even in the absence of objective data to support it. This report was conceived to evaluate the angiographic and clinical effects of calcium channel blocker therapy during the first postoperative year. Patients and results A total of 100 consecutive patients who received a radial artery graft at our institution were randomly assigned to receive (n = 53) or not...
27 CitationsSource
#1Gianfederico Possati (CUA: The Catholic University of America)H-Index: 30
#2Mario Gaudino (CUA: The Catholic University of America)H-Index: 30
Last. Giovanni Schiavoni (CUA: The Catholic University of America)H-Index: 18
view all 9 authors...
BACKGROUND: No information is available on the long-term results of radial artery (RA) grafts used as coronary artery bypass conduits. METHODS AND RESULTS: In this report, we describe the long-term (105+/-9 months) angiographic results of a series of 90 consecutive patients in whom the RA was used as a coronary artery bypass conduit directly anastomosed to the ascending aorta. The long-term patency and perfect patency rates of the RA were 91.6% and 88%, respectively, versus 97.5% and 96.3% for i...
194 CitationsSource
#1Mario GaudinoH-Index: 30
#2Franco GliecaH-Index: 23
Last. Gianfederico PossatiH-Index: 30
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Background This study was conceived to elucidate the clinical and angiographic effects of chronic calcium channel blocker therapy (CCCBT) continued after the first postoperative year in patients in whom the radial artery (RA) was used for myocardial revascularization. Methods and Results Patients who received RA grafts at our institution and who at 1 year had no scintigraphic evidence of ischemia in the RA territory or angiographic evidence of RA malfunction (n=120) were randomly assigned to con...
43 CitationsSource
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#1Mario Gaudino (Cornell University)H-Index: 30
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Abstract Background We used a large patient-level dataset including six angiographic randomized trials (RCTs) on coronary artery bypass conduits to explore incidence and determinants of coronary graft failure. Methods Patient-level angiographic data of six RCTs comparing long-term outcomes of the radial artery and other conduits were joined. Primary outcome was graft occlusion at maximum follow-up. The analysis was divided as follows: 1) left anterior descending coronary (LAD) distribution, 2) n...
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#1Hanjay Wang (Stanford University)H-Index: 6
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Last. H Boyd Jack (Stanford University)H-Index: 8
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ObjectiveEndoscopic radial artery (RA) harvesting performed concurrently with internal mammary artery (IMA) takedown and endoscopic saphenous vein (SV) harvesting creates a crowded and inefficient ...
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