RARAY Operation: Operative Description and Early Results for Achieving Total Arterial Coronary Revascularisation
Alistair G Royse1, Stuart Boggett2, Viju Abraham3
1Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia.
Insights
The Radial Artery Y-graft (RARAY) offers a promising alternative for total arterial revascularisation in coronary artery bypass grafting. This novel technique demonstrated satisfactory early outcomes, avoiding saphenous vein graft failure and left internal mammary artery harvest complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease
Background:
- Total arterial revascularisation aims to improve long-term survival post-coronary surgery by preventing late saphenous vein graft failure.
- Left internal mammary artery (LIMA) use in coronary artery bypass grafting (CABG) can negatively impact lung function and sternal blood supply.
- A novel Radial Artery Y-graft (RARAY) reconstruction using only radial arteries is presented as an alternative.
Purpose of the Study:
- To present early experience with the RARAY operation for total arterial revascularisation.
- To evaluate the feasibility and safety of using two radial arteries as a Y-graft for CABG.
- To explore an alternative to LIMA harvest and SVG use in specific patient populations.
Main Methods:
- The RARAY technique involves anastomosing one radial artery (RA) to the aorta for the left anterior descending territory.
- A second RA is joined to the first, revascularising the circumflex and right coronary territories.
- No LIMA was used; RAs were harvested openly, with vasoconstrictors administered since 2008.
Main Results:
- Twenty-eight patients underwent RARAY between 2002 and 2019 for specific indications.
- No radial artery spasm, in-hospital mortality, or return of angina symptoms were observed.
- Indications included prior LIMA use avoidance, lung function preservation, and minimizing bleeding risk.
Conclusions:
- The early results of the RARAY operation for three-vessel coronary territory revascularisation are satisfactory.
- This technique provides a viable option for total arterial revascularisation, potentially improving long-term outcomes.
- RARAY addresses limitations associated with LIMA harvest and SVG use.
Background:
Total arterial revascularisation may prolong postoperative survival following coronary surgery due to avoidance of late saphenous vein graft (SVG) failure leading to ischaemic cardiac events. The left internal mammary artery (LIMA) is routinely used for CABG but harvest may adversely affect lung function and reduce sternal vascular supply. Early experience of a novel reconstruction with exclusive reliance on two radial arteries (RA) joined as a Y graft (RARAY) is presented.
Methods:
One RA is anastomosed to the ascending aorta and used to revascularise the left anterior descending artery coronary territory; and a second RA is joined to the first 4-6 cm from the origin, approximating the lateral border of the pulmonary artery and used to revascularise the circumflex and right coronary territories. No LIMA is used. The radial artery was harvested open with diathermy and metal clips and since 2008, all patients received intravenous vasoconstrictors from the commencement of the anaesthetic.
Results:
From 2002 to 2019, 28 patients underwent RARAY for specific indications of prior use or reasons to avoid LIMA harvest, preservation of lung function, minimisation of bleeding risk from antiplatelet agents and extra length of RA to graft distal coronary targets beyond usual reach for LIMA. There was no RA spasm, no in-hospital death and no patient returned with symptoms of angina.
Conclusions:
The early experience of the RARAY operation for three coronary territory revascularisations are satisfactory.
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