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Ann Thorac Surg 2009;88:31-39. doi:10.1016/j.athoracsur.2009.03.081
© 2009 The Society of Thoracic Surgeons
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Thomas A. Schwann
Anoar Zacharias
Christopher J. Riordan
Samuel J. Durham
Aamir S. Shah
Robert H. Habib
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Original Articles: Adult Cardiac

Sequential Radial Artery Grafts for Multivessel Coronary Artery Bypass Graft Surgery: 10-Year Survival and Angiography Results

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

a Division of Cardiothoracic Surgery, Saint Vincent Mercy Medical Center, Toledo, Ohio
b Yvonne Viens, SGM, Research Institute, Saint Vincent Mercy Medical Center, Toledo, Ohio
c Departments of Medicine and Surgery, University of Toledo College of Medicine, Toledo, Ohio

Accepted for publication March 27, 2009.

* Address correspondence to Dr Habib, Cardiovascular and Pulmonary Research, Yvonne Viens, SGM, Research Institute, St. Vincent Mercy Medical Center, 2222 Cherry St, MOB2, Suite 1250, Toledo, OH 43608 (Email: robert_habib{at}mhsnr.org).

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

Background: Increasing the number of arterial grafts for coronary artery bypass grafting (CABG) has been linked to improved late survival. Currently, it is not known if these long-term benefits are also true when sequential radial artery (RA) grafts are the primary means to maximizing arterial revascularization.

Methods: We compared late survival of 532 consecutive patients receiving sequential RA grafts (sequential RA group: 438 men; 462 with three-vessel disease) with that of a 4,131 contemporaneous internal thoracic artery (ITA) with saphenous vein (SV) multivessel CABG cohort (conventional group). Graft failure rates were determined from symptom-driven repeat angiography films in 122 sequential RA patients performed 2 to 4,317 days after surgery. Median survival sequential RA follow-up was 5.3 years (range, 0.5 to 12.3).

Results: The sequential RA patients received a total of 1,181 RA grafts (538 sequential [30 triple] and 75 single) along with 636 SV and 533 ITA. Overall RA graft failure (80 of 272; 29%) was intermediate to that for ITA (7 of 121; 5.8%; p < 0.001) and vein (54 of 133, 41.6%; p = 0.032) grafts. Sequential versus nonsequential RA failure did not differ (77 of 252 [31%] versus 3 of 20 [15%]; p = 0.202), while failure of the proximal (36 of 123; 29%) and distal (40 of 129; 31%) components of sequential RA grafts were essentially identical. A total of 69 deaths (6 operative; 1.1%) have occurred in the sequential RA cohort. Unadjusted 10-year sequential RA cohort survival was 76.2% overall, and 79.0% for the 454 primary isolated CABG subgroup. The risk-adjusted 10-year survival using a logit propensity score was substantially better for the sequential RA cohort versus the conventional CABG cohort (risk ratio [95% confidence interval] 0.61 [0.44 to 0.85]; p = 0.003).

Conclusions: Sequential RA grafting is a safe method for maximizing arterial revascularization and is associated with excellent 10-year survival that seems to be superior to conventional or ITA/SV CABG results. Also, the similar proximal and distal sequential RA patency mitigates concerns of a clinically significant effect of increased vasoreactivity of distal segments of RA conduits.


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Invited Commentary
Donald D. Glower
Ann. Thorac. Surg. 2009 88: 39. [Extract] [Full Text] [PDF]



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D. D. Glower
Invited commentary.
Ann. Thorac. Surg., July 1, 2009; 88(1): 39 - 39.
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