The radial artery in coronary re-operations
J Tatoulis1, B F Buxton, J A Fuller
1Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Melbourne, Australia. james.tatoulis@mh.org.au
Insights
The radial artery (RA) is a safe and effective conduit for re-do coronary artery bypass grafting (CABG), reducing infections and potentially preventing future vein graft failure.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting
Background:
- Vein graft failure is a common cause of re-operation (re-do CABG).
- Internal thoracic arteries and vein grafts are often previously utilized in re-do CABG.
- The radial artery presents a viable alternative conduit when other options are exhausted.
Purpose of the Study:
- To evaluate the safety and efficacy of using the radial artery (RA) as a primary conduit in re-do coronary artery bypass grafting (CABG).
- To compare outcomes of re-do CABG using RA versus those without RA utilization.
- To assess the impact of RA use on infection rates and long-term survival.
Main Methods:
- A retrospective study of 352 consecutive patients undergoing re-do CABG with RA utilization (July 1995-March 1999).
- Comparison group comprised 730 patients undergoing re-do CABG without RA (January 1990-June 1995).
- Standardized operative and myocardial protection techniques were employed in both groups; follow-up was conducted over three years.
Main Results:
- The RA group experienced significantly lower rates of deep sternal infection (0.6% vs. 2.6%) and donor site infection (0.3% vs. 2.7%) compared to the non-RA group.
- Operative mortality was 3.9% in the RA group, with no significant difference in three-year actuarial survival (89.2% vs. 88.5%) between groups.
- No cases of hand ischemia were reported in the RA group.
Conclusions:
- The radial artery is a safe and effective arterial conduit for re-do coronary artery bypass grafting (CABG).
- Utilizing the radial artery in re-do CABG reduces donor site and sternal infections.
- Radial artery grafting offers an additional conduit choice and may prevent late vein graft failure.
Objectives:
Vein graft (VG) failure often leads to coronary re-operation (re-do coronary artery bypass grafting (CABG)). As the internal thoracic artery (ITA(s)) and VG have often already been used and as the VG has usually failed, the radial artery (RA) is ideally suited for use in re-do CABG. We evaluated our experience where the RA(s) was a key conduit in re-do CABG to determine the safety and efficacy and compared this to re-operations where the RA was not used.
Methods:
Three hundred and fifty-two consecutive patients who had re-do CABG using the RA(s) from July 1995 to March 1999 were studied: mean age 67.3 years, 209 (60%) angina Class III or IV, past acute myocardial infarction (AMI) in 201 (57%), left ventricular ejection fraction <50% in 109 (31%). Five hundred and thirty-two RAs were used (bilateral in 180 (51%) patients). Additionally, 232 new left ITAs (66% of patients) and 71 new right ITAs (20% of patients) were placed. A total of 1022 distal anastomoses were performed (mean of 2.9 per patient). Follow-up was at 1 month, 3 months, and yearly. The results were also compared to 730 patients having re-do CABG without an RA (January 1990 to June 1995) using identical operative and myocardial protection techniques.
Results:
RA spasm was noted intra-operatively in four (1.1%) patients, operative mortality was noted in 14 (3.9%) patients, peri-operative myocardial infarction was noted in ten (2.8%) patients, intra-aortic balloon pump was used in nine (2.6%) patients, stroke was noted in six (1.7%) patients, deep sternal infection was noted in two (0.6%) patients, and re-operation for haemorrhage was performed in seven (2.0%) patients. There was only one (0.3%) forearm infection, and two (0.6%) forearm haematomas required drainage. There was no hand ischaemia. When compared to 730 re-do CABG patients without RA, there were significant differences in arterial grafts used (2.6 vs. 1.2, P=0.01), in deep sternal infection (0.6% vs. 2.6%, P=0.01) and donor site infection (0.3% vs. 2.7%, P=0.005) favouring the RA group. Three-year actuarial survival was 89.2% in the RA group and 88.5% in the non-RA group (P=1.0).
Conclusions:
Use of the RA in re-do CABG is safe, effective, allows additional conduit choice, reduces donor site and sternal infections, and may avoid further late VG failure.
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