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Published on: April 1, 2022
Radial artery graft in coronary artery bypass surgery 1 week to 1 year postoperation
Yun Liu1, Kaijie Qin1, Jiaxi Zhu1
1Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Radial artery (RA) grafts show lower patency than saphenous vein (SV) grafts initially after coronary artery bypass grafting (CABG). However, graft patency becomes comparable at one year due to RA graft improvement and lower attrition.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Medical Imaging
Background:
- Limited data exists on the long-term patency rates of radial artery (RA) grafts after coronary artery bypass grafting (CABG).
- Comparing RA graft patency with traditional saphenous vein (SV) grafts is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate and compare the patency rates of radial artery (RA) grafts versus saphenous vein (SV) grafts at one week and one year post-coronary artery bypass grafting (CABG).
- To assess graft performance using coronary computed tomography angiography (CCTA).
Main Methods:
- An observational cohort study included 80 patients undergoing CABG with RA and SV grafts.
- Coronary computed tomography angiography (CCTA) was used for follow-up assessments at approximately one year post-operation.
- Grafts were graded (A: excellent, B: <50% diameter, O: occluded, S: string sign), with S and O defined as graft failure.
Main Results:
- One-week patency rates: LIMA 98.7%, RA 76.3%, SV 93.8%.
- One-year patency rates: LIMA 97.4%, RA 80.0%, SV 81.3%.
- RA grafts showed significantly lower patency than SV grafts perioperatively (P=0.007), but patency rates were similar at one year (P>0.99) due to RA graft improvement and lower deterioration rates.
Conclusions:
- Radial artery grafts exhibit lower initial patency compared to saphenous vein grafts after CABG.
- Despite initial differences, radial artery and saphenous vein graft patency rates become comparable at one year post-CABG.
- The "revival" phenomenon and reduced attrition in RA grafts contribute to their comparable long-term patency.
Background:
The actual patency rate of the radial artery (RA) grafts 1 week and 1 year after coronary artery bypass grafting (CABG) has not been extensively reported on. We used coronary computed tomography angiography (CCTA) to evaluate the patency rate of RA grafts and compared it with that of saphenous vein (SV) grafts.
Methods:
In this observational cohort study, 80 patients who underwent urgent or elective CABG with RA and SV grafts at Ruijin Hospital from August 2019 to June 2021 were included. Follow-up CCTA scans were completed about 1 year postoperation in the out-patient clinic. We graded the grafts into four classes: A, excellent; B, graft diameter <50% of target coronary artery; O, occluded; and S, string sign. Both S and O were defined as graft failure.
Results:
The patients' mean age was 58.48±8.06 years, and 87.5% (70/80) of the patients were male. The 1-week patency rate of the left internal mammary artery (LIMA), RA, and SV grafts were 98.7% (75/76), 76.3% (61/80), and 93.8% (75/80), respectively. At 1 year, the patency rate of the LIMA, RA, and SV grafts were 97.4% (74/76), 80.0% (64/80), and 81.3% (65/80), respectively. The RA graft patency rate was lower than was the SV graft patency rate perioperatively [relative risk (RR): 0.918; 95% confidence interval (CI): 0.852-0.990; P=0.007]. Moreover, 63.6% (7/11) of RA grafts graded S and 25.0% (2/8) of RA grafts graded O were defined as patent (graded A or B) at 1 year postoperation. Compared with SV grafts, more RA grafts improved (RA: 12/80, 15.0%; SV: 0%) and fewer RA grafts deteriorated (RV: 10/80, 12.5%; SV: 19/80, 23.8%) from 1 week to 1 year (P=0.001). The patency rate of the 2 types of grafts became similar at 1 year postoperation (RR: 0.560; 95% CI: 0.113-2.781; P>0.99).
Conclusions:
RA grafts had a lower patency rate than did SV grafts 1 week after operation. However, because of the "revival" phenomena and lower attrition rate, the patency rate of the two kinds of grafts did not show any significant difference at 1 year.
