Multiple arterial grafts. Radial versus right internal thoracic arteries

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Left internal thoracic artery (LITA) grafts to the left anterior descending coronary artery (LAD) demonstrate superior patency and long-term outcomes in coronary artery bypass grafting (CABG).
• The advantages of employing multiple arterial grafts and the comparative performance of different arterial conduits remain subjects of ongoing debate.
• This study addresses the controversy by comparing single versus multiple arterial grafts and evaluating the right internal thoracic artery (RITA) against the radial artery (RA) as a second arterial conduit.

Purpose of the Study:

• To compare perioperative and intermediate-term outcomes between patients receiving one versus two arterial grafts during CABG.
• To evaluate the safety and efficacy of using a radial artery (RA) compared to a right internal thoracic artery (RITA) as the second arterial graft.

Main Methods:

• Retrospective analysis of prospectively collected data from isolated CABG patients between 1989 and 1996.
• Comparison of outcomes for single arterial graft (LITA to LAD) versus double arterial grafts (LITA + RA or LITA + RITA).
• Sub-analysis comparing RITA versus RA as the second arterial graft for patients undergoing double arterial grafting since 1992.

Main Results:

• Single arterial grafting was associated with a significantly increased incidence of perioperative cardiac morbidity and mortality (OR 2.2).
• Double arterial grafting showed a trend towards improved intermediate-term survival and cardiac event-free survival, though not statistically significant.
• Radial artery (RA) grafts, compared to RITA grafts, were associated with a shorter intensive care unit stay, but a higher incidence of diabetes, peripheral vascular disease, and elderly age in the patient cohort. RITA grafts had a higher rate of sternal wound infection and blood product transfusion.

Conclusions:

• The utilization of two arterial grafts in CABG is safe and effectively reduces perioperative cardiac morbidity and mortality compared to single arterial grafts.
• When used as a second arterial graft, the radial artery (RA) demonstrates a lower incidence of sternal wound infection and reduced transfusion requirements compared to the right internal thoracic artery (RITA).
• There were no significant differences in perioperative or intermediate-term cardiac morbidity or mortality rates between RITA and RA grafts.