冠動脈血行再建術における連続的橈骨動脈グラフトの安全性評価

Use of the radial artery (RA) as a conduit during coronary artery bypass grafting is associated with better outcomes compared with vein. However, data on the RA as a sequential graft are limited. This study assessed the safety and efficiency of using sequential RA grafting.

Patients with sequential vs nonsequential RA grafting by 1 surgeon from 2 hospitals from 2001 to 2022 were compared using propensity matching. Primary outcomes were total artery revascularization (TAR) and incomplete revascularization. Secondary outcomes included cardiopulmonary bypass and cross-clamp times, total number of arterial grafts, 30-day mortality, and complications. The Mann-Whitney U test, χ² test, and propensity matching were used.

Of 517 patients who received RA grafting, 107 (20.7%) were sequential. After matching, there were 107 patients in the sequential group and 321 in the nonsequential group. Sequential RA use was associated with more TAR (P < .001) and less incomplete revascularization (P = .002). Matched patients with sequential RA grafting and 4 grafts had shorter bypass and cross-clamp times (P < .001). No differences were observed in clinical outcomes between matched groups.

Patients with sequential RA grafting had more TAR with equivalent outcomes compared with those with single RA. These findings support the safety and efficiency of sequential RA grafting.