The radial artery in reoperative coronary bypass surgery:
J Tatoulis1, B F Buxton, J A Fuller
1Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia. james.tatoulis@mh.org.au
Insights
Radial artery grafts (RA) offer excellent results in repeat coronary artery bypass grafting (CABG), achieving total arterial revascularization in 92% of cases. This study shows RA use in redo CABG is a safe and effective option for patients needing repeat procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease
Background:
- Saphenous vein graft (SVG) failure is a common reason for repeat coronary artery bypass grafting (redo CABG).
- The radial artery (RA) is a suitable alternative conduit, often used with internal thoracic arteries (ITA), particularly for failed SVG replacement.
- This study evaluates the 5-year experience of using RA as a primary conduit in redo CABG.
Purpose of the Study:
- To assess the outcomes of using radial artery (RA) grafts, in conjunction with internal thoracic arteries (ITA), for repeat coronary artery bypass grafting (redo CABG).
- To compare the results of redo CABG with RA conduits to historical controls and contemporary primary CABG procedures.
Main Methods:
- A cohort of 590 patients undergoing redo CABG between July 1996 and June 2002 used one or both RA(s) with LITA or RITA.
- Patients had a mean age of 67.3 years, with significant comorbidities including angina, left main stenosis, and reduced left ventricular ejection fraction (LVEF).
- Follow-up was conducted postoperatively and annually, with results compared to a prior redo CABG cohort without RA and to contemporary primary CABG patients.
Main Results:
- The 30-day mortality was 3.9%, with low rates of perioperative morbidity including myocardial infarction (2.7%) and stroke (1.7%).
- Outcomes were superior to a prior redo CABG cohort that did not utilize RA grafts.
- However, results were inferior to contemporary primary CABG, with higher operative mortality (3.9% vs. 0.9%) and myocardial infarction rates (2.7% vs. 0.8%).
Conclusions:
- The use of radial artery (RA) grafts combined with internal thoracic arteries (ITA) in redo CABG enables total arterial revascularization in 92% of patients.
- This approach yields excellent outcomes, comparable or superior to previous redo CABG methods.
- While results are inferior to primary CABG, RA offers a valuable option for achieving arterial revascularization in repeat bypass surgery.
Background:
Failure of saphenous vein grafts (SVG) is a significant cause for coronary reoperation (redo CABG). The radial artery (RA) because of its availability, and versatility is well suited to use (together with internal thoracic arteries (ITA) in redo CABG, especially to replace failed SVG. We evaluated our experience where the RA was a major conduit in redo CABG over the past 5 years.
Methods:
From July 1996 to June 2002, 590 consecutive patients underwent redo CABG where one or both RA(s) were used, together with LITA or RITA. The mean age was 67.3 years, 82% were male, and 19% diabetic, 419 (71%) had Class III or IV angina, 135 (23%) had left main stenosis, and 210 (36%) had an LVEF < 0.50. There were a total of 877 RA conduits (303 single, 287 bilateral), 518 new LITA or RITA. A mean of 2.8 new distal anastomoses constructed 92% (2.6 per patient)of the arterial grafts. Follow-up was at 1 month, 3 months, and then yearly. The results were compared with 6466 primary CABG performed in the same time frame, and with a prior cohort of 741 consecutive patients having redo CABG without an RA in which identical operative techniques had otherwise been used.
Results:
The 30-day mortality was 3.9% (23 patients). Morbidity was low. Perioperative myocardial infarction occurred in 16 (2.7%) patients, stroke in 10 (1.7%), sternal infection in 10 (1.7%), donor site infection in 2 (0.3%), and IABP use in 23 patients (3.9%)-including 10 preoperatively. The results were better when compared to a prior cohort of 741 patients with redo CABG (1991 to 1996) without use of the RA. The results were inferior to that of the contemporary primary CABG. Operative mortality was 3.9% versus 0.9%, p = 0.002, myocardial infarction 2.7% versus 0.8%, p = 0.03.
Conclusion:
The use of the RA (together with ITA) in redo CABG achieved total arterial revascularization in 92% of cases and is associated with excellent results, at least equal to or superior to those achieved previously.
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