Radial artery achieves better flowmetric results than saphenous vein in the elderly

Due to the limited life expectancy and the supposed higher morbidity with complete arterial grafting, extensive arterial graft in the elderly is still questioned. It was the aim of this study to evaluate transit time flow and clinical, biochemical and echocardiographic results of elderly patients undergoing coronary artery bypass grafting (CABG) with either saphenous vein (SV) or radial artery (RA) employed as the second conduit of choice. The present study evaluates clinical and flowmetric results of a prospective series of elderly patients (>or=70 years old) undergoing RA CABG (75 patients, Group A) or SV CABG (163 patients, Group B) during isolated myocardial revascularization, performed either off-pump (OPCABG) and on-pump during the last 5 years at a single academic institution (between January 2003 and December 2007). Transit time flowmetric (TTF) maximum and mean flow, pulsatility index (P.I.), and graft flow reserve (GFR) were compared. Hospital outcome was analyzed. Clinical data were compared between the two groups and one-year follow-up was completed. The two groups showed comparable preoperative and intraoperative variables. When TTF analysis was considered, patients undergoing RA grafting demonstrated a significantly higher maximum (systolic) and mean flow compared to SV grafting, either in circumflex, diagonal, and right coronary territory. Pulsatility index was significantly lower in the RA group in circumflex, diagonal, and right coronary grafts. Furthermore, when GFR was calculated significantly higher values were found in RA conduits in the circumflex, diagonal, and right coronary grafts. Comparable troponin I leakage was detected between the two groups. Postoperative variables addressing hospital outcome were similar in the two groups. When echocardiographic data were analyzed, no differences were recorded in postoperative recovery of left ventricular ejection fraction and wall motion score index. One-year follow-up showed better freedom from acute cardiovascular events in the RA group (P = 0.04). Our data show that despite comparable clinical, biochemical, and echocardiographic results in elderly patients undergoing RA or SV grafting, better flowmetric results - in terms of GFR, mean flow, and pulsatility index - can be detected in arterial conduits.