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Radial artery graft use and off-pump coronary artery bypass surgery outcome
Ahmet T Gurbuz1, Orhan Findik, Haiyan Cui
1Department of Cardiothoracic Surgery, Tucson Medical Center, University of Arizona, Tucson, USA. atgurbuz@yahoo.com
Insights
The use of radial artery grafts in off-pump coronary artery bypass surgery was linked to a higher incidence of symptom recurrence and adverse cardiac events. This finding suggests caution when selecting radial artery grafts for these procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Cardiac Revascularization
Background:
- Radial artery is frequently employed as a conduit for surgical revascularization.
- Limited data exists on the impact of radial artery utilization on outcomes after off-pump coronary artery bypass (OPCAB).
Purpose of the Study:
- To prospectively evaluate the effect of radial artery graft use on clinical outcomes in patients undergoing OPCAB.
Main Methods:
- Prospective evaluation of 591 patients undergoing OPCAB.
- Comparison of outcomes between patients with (n=398) and without radial artery grafts.
- Multivariate Cox regression analysis to identify predictors of adverse events.
Main Results:
- Radial artery graft use was an independent predictor of increased symptom recurrence and adverse cardiac events.
- Patients with radial artery grafts showed a trend towards more angina recurrence, coronary re-intervention, and sudden cardiac death.
- No significant differences in preoperative risk factors were observed between groups.
Conclusions:
- Radial artery grafting in OPCAB is associated with a higher risk of symptom recurrence and adverse cardiac events.
- Further research is warranted to understand the mechanisms behind these findings and optimize graft selection.
- These results suggest a need for careful consideration of radial artery use in OPCAB procedures.
Abstract:
Radial artery is commonly used as a conduit for surgical revascularization. There is scarce data on the effect of radial artery use on outcome following off-pump coronary artery bypass. We prospectively evaluated 591 patients undergoing off-pump coronary artery bypass. Radial artery grafts were used in 398 of these patients (mean age, 67.6 +/- 10.4 years; mean follow-up, 37.7 +/- 13.4 months). Symptom recurrence (angina, congestive heart failure), adverse cardiac events (myocardial infarction, coronary re-intervention, sudden cardiac death), and overall mortality were recorded. Multivariate Cox regression analysis was used to evaluate predictors of endpoints. Patients with and without radial artery grafts were similar with respect to preoperative risk factors. Recurrent angina developed in 29 patients, congestive heart failure in 5, and myocardial infarction in 9. Coronary arteriography was performed in 27 patients, and 23 underwent re-intervention. Radial artery graft was an independent predictor of increased symptom recurrence and adverse cardiac events. Patients with radial artery grafts also had a tendency towards more angina recurrence, coronary re-intervention, and sudden cardiac death.
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