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Association between bilateral radial artery grafting and long-term survival after coronary artery bypass surgery
Garry W Hamilton1,2, Justin Ren3,4, David M Chye1,2
1Department of Cardiology, Austin Health, Melbourne, Australia.
Insights
Using bilateral radial artery (RA) grafts in coronary artery bypass grafting (CABG) significantly improves long-term survival compared to single or no RA use. Preservation of both RAs is recommended for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Outcomes
Background:
- The radial artery (RA) is a crucial graft in coronary artery bypass grafting (CABG), second only to the left internal thoracic artery.
- Assessing the survival benefits of using bilateral RAs is important for optimizing CABG procedures.
Purpose of the Study:
- To evaluate the long-term survival advantage of utilizing bilateral radial artery grafts in patients undergoing CABG.
- To compare survival outcomes between patients receiving no RA, single RA, and bilateral RA grafts.
Main Methods:
- Retrospective analysis of prospectively collected data from a binational database (2001-2020).
- Inclusion of patients undergoing CABG with at least two grafts.
- Stratification into three groups: no RA (RA-0), single RA (RA-1), and bilateral RA (RA-2) use.
- Application of inverse probability of treatment weighting (IPTW) to adjust for baseline differences.
- Analysis of long-term all-cause mortality as the primary outcome.
Main Results:
- A total of 59,608 patients were analyzed (RA-0: 31,190; RA-1: 22,741; RA-2: 5,677).
- Both single RA (HR, 0.85) and bilateral RA (HR, 0.74) use were associated with improved survival compared to no RA use.
- Bilateral RA use showed superior survival benefit over single RA use (HR, 0.87).
- Total arterial revascularization rates were significantly higher in RA-1 (46.2%) and RA-2 (81.0%) groups compared to RA-0 (7.1%).
Conclusions:
- Bilateral radial artery grafting offers a significant survival advantage in CABG compared to single or no RA use.
- Increased utilization of radial artery conduits in CABG is recommended.
- Preserving both radial arteries is advised when CABG is anticipated to maximize grafting options and survival benefits.
Objectives:
Radial artery (RA) is recommended as a graft for the second most important coronary target after the left internal thoracic artery-to-left anterior descending artery graft. This study assessed the survival benefit associated with bilateral RA use in coronary artery bypass grafting (CABG).
Methods:
This was a retrospective analysis of prospectively collected data from a binational database including patients who underwent CABG with ≥2 grafts from 2001 to 2020. Patients were stratified into 3 groups: no RA (RA-0), single RA (RA-1), and bilateral RA (RA-2) use. Inverse probability of treatment weighting was used to adjust for baseline differences. The outcome analyzed was long-term all-cause mortality.
Results:
Of the 59,608 patients included, there were 31,190, 22,741, and 5677 patients in the RA-0, RA-1, and RA-2 groups, respectively. The median postoperative follow-up was 5.0 years (interquartile range, 2.3-8.6 years), with a maximum follow-up of 17.9 years. Compared with RA-0, both RA-1 (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89) and RA-2 (HR, 0.74; 95% CI, 0.67-0.82) were associated with improved survival. RA-2 also demonstrated benefit over RA-1 use (HR, 0.87; 95% CI, 0.79-0.97). Inverse probability of treatment weighting was used to balance comparisons, and the proportional hazards assumption was satisfied (P = .10). Total arterial revascularization was achieved in 7.1%, 46.2%, and 81.0% of RA-0, RA-1, and RA-2 groups, respectively.
Conclusions:
Bilateral RA grafting was associated with superior long-term survival compared with the use of 1 RA or no RA conduit. Increased adoption of RA conduits in CABG is encouraged, and preservation of both RAs is recommended when CABG is anticipated.
