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 < 0.001 for ITA vs. saphenous vein). Target vessel stenosis >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 < 0.05) and correlated with the peak systolic velocity of the second palmar digital artery (Pearson coefficient: 0.621; p < 0.05). 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.

Gaudino, M. F. L., Tondi, P., Benedetto, U., Milazzo, V., Flore, R. A., Glieca, F., Ponziani, F. R., Luciani, N., Girardi, L. N., Crea, F., Massetti, M., Radial Artery as a Coronary Artery Bypass Conduit: 20-Year Results, <<JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY>>, 2016; 68 (6): 603-10-610. [doi:10.1016/j.jacc.2016.05.062] [http://hdl.handle.net/10807/92721]

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

Gaudino, Mario Fulvio Luigi
Primo
;
Tondi, Paolo
Secondo
;
Milazzo, Valentina;Flore, Roberto Antonio;Glieca, Franco;Ponziani, Francesca Romana;Luciani, Nicola;Crea, Filippo
Penultimo
;
Massetti, Massimo
Ultimo
2016

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 < 0.001 for ITA vs. saphenous vein). Target vessel stenosis >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 < 0.05) and correlated with the peak systolic velocity of the second palmar digital artery (Pearson coefficient: 0.621; p < 0.05). 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.
Inglese
Gaudino, M. F. L., Tondi, P., Benedetto, U., Milazzo, V., Flore, R. A., Glieca, F., Ponziani, F. R., Luciani, N., Girardi, L. N., Crea, F., Massetti, M., Radial Artery as a Coronary Artery Bypass Conduit: 20-Year Results, <>, 2016; 68 (6): 603-10-610. [doi:10.1016/j.jacc.2016.05.062] [http://hdl.handle.net/10807/92721]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/92721
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