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Comparison of Patency Between Sequential and Individual Radial Artery Anastomoses in Coronary Artery Bypass Grafting
Siyu Zhang1, Chunyuan Wang1, Zhan Hu1
1Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, 100037 Beijing, China.
Insights
Sequential radial artery (RA) grafting for coronary artery bypass grafting (CABG) increases the risk of graft occlusion. To improve long-term patency, target only one vessel per RA graft, especially if it has significant stenosis.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Arterial Revascularization
Background:
- Multiple arterial grafts enhance long-term survival in coronary artery bypass grafting (CABG).
- Sequential radial artery (RA) grafting is a method to maximize arterial revascularization.
- The study investigates the patency of RA conduits in sequential versus individual grafting.
Purpose of the Study:
- To compare the patency rates of sequential versus individual radial artery (RA) grafts in CABG patients.
- To identify risk factors for RA graft occlusion.
- To provide evidence-based recommendations for optimizing arterial grafting strategies.
Main Methods:
- Retrospective study of 274 CABG patients receiving at least one RA graft (January 2017 - June 2021).
- Assessment of RA graft occlusion using postoperative computed tomography angiography or coronary angiography.
- Analysis of long-term outcomes using adjusted Cox regression models.
Main Results:
- Sequential anastomoses were identified as an independent risk factor for RA graft occlusion (aHR = 2.45, p=0.020).
- The overall occlusion rate was low at 2.9%.
- Graft occlusion risk was minimal when sequential RA grafts targeted vessels with a quantitative flow ratio of ≤0.71.
Conclusions:
- Sequential RA grafting is associated with a higher risk of graft occlusion compared to individual grafting.
- Selecting a single target vessel with significant functional stenosis for each RA graft may lead to better long-term patency.
- Optimizing RA graft strategy is crucial for improving CABG outcomes.
Background:
Current evidence suggests that multiple arterial grafting improves long-term survival following coronary artery bypass grafting (CABG). Sequential radial artery (RA) grafting is known to be a safe approach for maximizing arterial revascularization. This study aimed to compare RA conduit patency between sequential and individual grafting.
Methods:
A total of 274 CABG patients who received at least one RA graft between January 2017 and June 2021 were included in our retrospective study. The occlusion of RA anastomoses was assessed by postoperative computed tomography angiography or coronary angiography at follow-up. Group comparisons for long-term outcomes were conducted using adjusted Cox regression models.
Results:
The median image follow-up time was 1.8 years. Among the 278 total RA grafts, 208 were individual and 70 were sequential. Multivariable Cox analysis found that sequential anastomoses were an independent risk factor for RA graft occlusion (adjusted hazard ratio = 2.45, 95% confidence interval (CI): 1.15-5.22; p = 0.020). However, the observed rate of occlusion was low (2.9%) when all the target vessels for a sequential graft had a quantitative flow ratio of ≤0.71.
Conclusions:
Sequential RA grafting is associated with graft occlusion compared with individual grafting. For each RA graft, the selection of only one target vessel with significant functional stenosis may be preferable to achieve superior long-term patency.
