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Original Articles: Adult Cardiac

Long-Term Patency of 1108 Radial Arterial-Coronary Angiograms Over 10 Years

^a Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
^b University of Melbourne, Melbourne, Victoria, Australia
^c Department of Cardiothoracic Surgery, Epworth Hospital, Melbourne, Victoria, Australia

Accepted for publication March 25, 2009.

^_* Address correspondence to Prof Tatoulis, Private Medical Centre, Ste 28, Royal Melbourne Hospital, Melbourne, Victoria, 3050, Australia (Email: james.tatoulis{at}mh.org.au).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: To avoid late vein graft atheroma and failure, we have used arterial grafts extensively in coronary operations. The radial artery (RA) is the conduit of second choice. This study determined the long-term patency of the RA as a coronary graft.

Methods: Two independent observers evaluated 1108 consecutive postoperative RA conduit angiograms performed between January 1997 and June 2007 for cardiac symptoms. Mean time to postoperative angiography was 48.3 months (range, 1 to 132 months). An RA graft was considered failed (nonpatent) if there was stenosis exceeding 60%, string sign, or occlusion. Patency was determined over time, by coronary territory grafted and by the degree of native coronary artery stenosis (NCAS).

Results: At a mean of 48.3 months, 982 of the 1108 RA grafts (89%) were patent. RA patencies for the left anterior descending were 96% (24 of 25), diagonal/intermediate, 90% (121 of 135); circumflex marginal, 89% (499 of 561); right coronary, 83% (38 of 46); posterior descending, 89% (253 of 286); and left ventricular branch/posterolateral, 86% (47 of 55). Patency was 87.5% (56 of 64) for NCAS of less than 60% compared with 89% (926 of 1044; p = 0.89) for NCAS exceeding 60%. Of 318 RAs in place more than 5 years, 294 (92.5%) were patent, and for 107 RAs in place for more than 7 years, 99 were patent (92.5%). Patency was consistent through each year of the decade. Mechanisms of failure did not involve development of atherosclerosis. Patent RA grafts were smooth, with no angiographic evidence of atheroma.

Conclusions: Late patencies of RA grafts are excellent and justify continuing use of the RA in coronary operations.