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Samuel J. Durham
Aamir S. Shah
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Ann Thorac Surg 2007;84:25-31
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Survival and Graft Patency After Coronary Artery Bypass Grafting With Coronary Endarterectomy: Role of Arterial Versus Vein Conduits

Thomas A. Schwann, MDa,b,c, Anoar Zacharias, MDa,b,c, Christopher J. Riordan, MDa,b,c, Samuel J. Durham, MDa,b,c, Aamir S. Shah, MDa,b,c, Robert H. Habib, PhDa,d,*

a Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio
b Division of Cardiovascular Surgery, St. Luke’s Hospital, Maumee, Ohio
c Department of Surgery, University of Toledo, College of Medicine, Toledo, Ohio
d Department of Medicine, University of Toledo, College of Medicine, Toledo, Ohio

Accepted for publication February 20, 2007.

* Address correspondence to Dr Habib, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry Street, ACC Bldg, Suite 309, Toledo, OH 43608 (Email: robert_habib{at}mhsnr.org).

Background: Coronary artery bypass grafting with concomitant coronary endarterectomy (CABG/CE) is used in patients with severe coronary atherosclerosis to revascularize otherwise ungraftable targets. This study investigates the efficacy of arterial versus vein grafting for CABG/CE surgery.

Methods: We reviewed our experience in 288 CABG/CE patients (63 ± 10 years, 207 men). A total of 1,056 grafts (275 internal thoracic artery [ITA] [26%]; 221 radial [21%], 560 vein [53%]) were constructed including 325 (31%) placed to CE targets.

Results: Eighteen of 288 patients died in-hospital (6.3%). Unadjusted one-year and five-year survival for the 270 discharged patients was 95.2% and 83.0%, respectively. Survival (0 to 7 years) was significantly better for patients with radial (n = 154) versus no-radial (n = 134) artery grafting (p = 0.021). Multivariate Cox regression analysis associated increased number of arterial grafts (hazard ratio [HR] = 0.64 [0.44 to 0.92]; HR [95% confidence interval]) to improved survival, while RCA endarterectomy (HR = 1.8 1.0 3.3; p = 0.054) was associated with worse survival. Repeat angiography (495 days [median]) in 68 patients encompassed 78 CE (38 vein, 24 ITA, and 16 radial) and 162 non-CE (84 vein, 40 ITA, and 38 radial) grafts. Graft failure was similar (p = 0.37) for radial (10 of 54 [19%]) and ITA (7 of 64 [11%]), and worst for vein (50 of 122 [41%]; p < 0.001). For CE targets, graft failure was worse for vein (55% vs 35%; p = 0.05) and unchanged for arterial (13% vs 15%; p = 0.88) grafts.

Conclusions: Combined CABG/CE is associated with good long-term outcomes. Increased arterial grafting achieved by radial artery utilization confers a survival benefit in this high-risk population. The latter is probably derived from superior radial versus vein graft patency.




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