The use of the radial artery for coronary artery bypass grafting improves long-term outcomes: And now what?

Twenty-year outcomes of free and I-composite radial artery grafts for coronary artery revascularization

PURPOSE

To compare the 20-year outcomes of coronary artery grafting (CABG) using radial artery (RA) grafts (free and I-composite) and internal thoracic artery (ITA) grafts.

METHODS

Long-term graft patency was evaluated in patients who underwent isolated CABG between August, 1996 and January, 2022. The long-term graft patency of free RA grafts, I-composite ITA-RA grafts, and saphenous vein (SV) grafts were compared.

RESULTS

The RA was used as a coronary bypass conduit in 111 of the 246 patients enrolled in this study. The RA patency after 10 and 20 years was 94.2% and 76.6%, respectively. Landmark analysis showed that although graft patency for up to 10 years did not differ between the RA and ITA grafts (hazard ratio = 0.87; P = 0.8), patency of the ITA grafts was better from 10 to 20 years post-surgery (hazard ratio = 0.19; P = 0.013). The 20-year graft patency of the I-composite RA grafts was better than that of the free RA grafts (80.0% vs. 72.4%; P = 0.029), but not significantly different from that of the ITA grafts (80.0% vs. 90.7%; P = 0.24).

CONCLUSIONS

The 20-year patency of the I-composite ITA-RA graft was better than that of the free RA graft; therefore, the I-composite graft may be an effective conduit for CABG.

Long-term survival in coronary artery bypass grafting surgery depending on the second conduit used

There is still debate whether radial artery (RA) conduits are better grafts then saphenous vein grafts (SVG) as a second conduit in coronary artery bypass grafting (CABG) surgery. Although it has been confirmed that RA grafts have significantly better patency over years, only some observational studies have associated RA use with reduced all-cause mortality. So far, no randomized controlled trial (CRT) has confirmed significantly better survival for RA graft recipients versus SVG recipients. Therefore, we have to wait for the results of the ongoing ROMA (CRT) study, to draw relevant conclusions about the impact of the second graft on long-term survival in patients undergoing CABG surgery.