Effect of the Proximal Anastomosis Configuration of the Radial Artery in Patients Undergoing Coronary Artery Bypass Grafting

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.

Graft Patency of No-Touch Saphenous Veins Used as Aortocoronary Bypass Grafts

Background

This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG).

Methods

In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated.

Results

The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively.

Conclusion

The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.

Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS)

PREAMBLE

The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS).