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Updated: Jul 5, 2025
Establishment and Evaluation of a Porcine Vein Graft Disease Model
Published on: July 25, 2022
Radial artery vs right internal mammary artery as a second conduit during coronary artery bypass grafting
Eishan Ashwat1, James A Brown1, Sarah Yousef1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
Insights
Radial artery (RA) grafts and right internal mammary artery (RIMA) grafts show similar survival after coronary artery bypass grafting (CABG). However, RA grafts had higher rates of repeat revascularization, especially in the grafted area.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a cornerstone treatment for severe coronary artery disease.
- Graft selection, including radial artery (RA) and right internal mammary artery (RIMA), significantly impacts long-term outcomes.
- Understanding the comparative efficacy of different arterial conduits is crucial for optimizing surgical strategies.
Purpose of the Study:
- To compare the clinical outcomes of radial artery (RA) grafts versus right internal mammary artery (RIMA) grafts in patients undergoing multiarterial coronary artery bypass grafting (CABG).
- To evaluate differences in long-term survival and major adverse cardiac and cerebrovascular events (MACCE) between RA and RIMA conduits.
Main Methods:
- Retrospective, single-institution cohort study of isolated CABG with multiple grafts (2010-2022).
- Propensity score matching (PSM) was used for 1:1 ratio matching to balance graft cohorts.
- Kaplan-Meier and cumulative incidence estimations were employed to compare long-term survival and MACCE, respectively.
Main Results:
- After PSM, 323 RA and 323 RIMA patients were analyzed, showing well-balanced baseline characteristics.
- No significant differences were observed in immediate postoperative complications or 5-year survival rates (RA: 89.5% vs. RIMA: 90.1%).
- A trend towards higher 5-year MACCE in the RA group (31.3% vs. 24.1%) was noted, driven by significantly higher rates of repeat coronary revascularization (14.7% vs. 5.3%) in the RA group, particularly in the territory grafted by RA.
Conclusions:
- Radial artery and right internal mammary artery grafts demonstrate comparable 5-year survival and MACCE rates following propensity score-matched CABG.
- Radial artery grafting is associated with a significantly higher incidence of repeat coronary revascularization within 5 years, especially in the revascularized territory.
- These findings suggest careful consideration of RA graft use, particularly regarding the potential for increased reintervention needs.
Objective:
To compare the clinical outcomes of radial artery (RA) grafts during CABG to those of right internal mammary artery (RIMA) grafts.
Methods:
This was a retrospective, single-institution cohort study of isolated CABG with multiple grafts between 2010-2022. To balance graft cohorts, propensity score matching (PSM) was performed using a 1:1 match ratio. Long-term postoperative survival was compared among RA and RIMA groups. Similarly, major adverse cardiac and cerebrovascular events (MACCE) were compared among both cohorts, with MACCE comprising death, myocardial infarction (MI), coronary revascularization, and stroke. Kaplan-Meier estimation was performed for mortality, while cumulative incidence estimation was utilized for MACCE.
Results:
A total of 8,774 patients underwent CABG. Of those, 1,674 (19.1%) patients who underwent multiarterial CABG were included in this analysis. 326 (19.5%) patients received RA grafts and 1,348 (80.5%) received RIMA grafts. PSM yielded a cohort of 323 RA patients and 323 RIMA patients. After matching, groups were well-balanced across all baseline variables. No significant differences were observed in immediate postoperative complications or long-term survival, with 5-year survival estimates of 89.5% for the RA group vs 90.1% for the RIMA group. There was a nonsignificant trend toward a higher incidence of MACCE at 5 years in the RA group compared to the RIMA group (31.3% in the RA group vs 24.1% in the RIMA group), especially after 1-year follow-up (21.6% in the RA group vs 15.1% in the RIMA group). Specifically, for RA patients, there were higher rates of repeat revascularization in the 5-year postoperative period (14.7% in the RA group vs 5.3% in the RIMA group), particularly in the territory revascularized by the RA during the index operation (45.7% in the RA group vs 10.3% in the RIMA group).
Conclusion:
Overall, RA and RIMA secondary conduits for CABG were associated with comparable immediate postoperative complications, 5-year MACCE, and 5-year survival after PSM. RA grafting was associated with significantly higher rates of repeat coronary revascularization at 5 years, specifically in the territory revascularized by the RA during the index operation.
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