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Ann Thorac Surg 2004;77:93-101
© 2004 The Society of Thoracic Surgeons
a Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia,
b Epworth Hospital, University of Melbourne, Melbourne, Victoria, Australia
* Address reprint requests to Dr Tatoulis, Suite 28, Private Medical Centre, Royal Melbourne Hospital, Parkville, Victoria, 3050 Australia.
e-mail: james.tatoulis{at}mh.org.au
Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
BACKGROUND: Use of arterial grafts in coronary surgery is based on the excellent patency of the left internal thoracic artery (LITA) and an expectation that other arterial grafts—right internal thoracic artery (RITA) and radial artery (RA)—will give similar patencies, superior to saphenous vein. We examined patencies of arterial grafts in a practice with extensive use for more than 15 years.
METHODS: Consecutive postoperative angiograms of 2,127 arterial/coronary conduits were evaluated. Angiograms were performed for cardiac symptoms. Assessment was by two observers. String signs were considered as occlusions.
RESULTS: There were 2,127 arterial conduits. Overall patencies were as follows: LITA, 96.4% (1,296 of 1,345); RITA, 88.3% (534 of 605); aortocoronary RA, 89.3% (158 of 177). The LITA patency to the left anterior descending artery was 97.1% (1,131 of 1,165); to the obtuse marginal artery it was 91.7% (165 of 180; p 0.01). The RITA pedicled graft patency was 86% (275 of 321) compared with free RITA, 91% (259 of 284; p = not significant). For RITA there was a hierarchy of patency for coronary territory grafted (left anterior descending artery best, right coronary/posterior descending artery worst) and for degree of coronary stenosis: if stenosis was less than 60%, patency was 65% (47 of 72); if stenosis was more than 60%, patency was 90.9% (485 of 533; p = 0.0001). Similarly for the radial artery there was higher patency with greater coronary stenosis. The LITA patency at 5 years was 98%, at 10 years it was 95%, and at 15 years it was 88%. The RITA patency at 5 years was 96%, at 10 years it was 81%, and at 15 years it was 65%. The radial artery patency at 1 year was 96% and at 4 years it was 89%. For 3,714 vein grafts also studied overall patency was 61% (2,266 of 3,214) with patencies of 95% at 5 years, 71% at 10 years, and 32% at 15 years.
CONCLUSIONS: Excellent long-term patencies of arterial grafts are noted, superior to those of vein grafts. Patencies were influenced by conduit, by distribution, and by coronary artery stenosis.
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