Ann Thorac Surg 2006;81:1551-1552
© 2006 The Society of Thoracic Surgeons
Correspondence
Reply
Lokeswara Rao Sajja, MCh,
Gopichand Mannam, FRCS(CT)
Division of Cardiothoracic Surgery, CARE Hospital, The Institute of Medical Sciences, Rd No. 1, Banjara Hills, Hyderabad 500 034, India
(Email: sajjalr{at}yahoo.com).
To the Editor:
We read with interest the comments of Nezic and colleagues [1] of our review [2], and we congratulate them for their update of recent articles published in the year 2004. The study published by Khot and colleagues [3] from the Cleveland Clinic included angiographic outcomes of 310 symptomatic patients who received a radial artery graft at a mean follow-up of 565 ± 511 days after coronary artery bypass showed a radial artery graft patency rate of 51.3%, which was lower than the saphenous vein grafts (64%; p < 0.0016). They reported that calcium channel blockers were administered early after surgery in 191 patients, and in the remaining 119 patients, calcium channel blockers were either not used (n = 37) or their usage could not be determined from the records (n = 82). The use of calcium channel blockers during harvesting of the radial artery was also not mentioned in 119 patients. The authors themselves mentioned a number of limitations of their study including selection bias, predominantly because patients with symptoms or signs of recurrent ischemia were studied. It was also not mentioned whether or not the target artery selection criteria for radial artery use was to bypass secondary targets with poor distal runoff or targets with subcritical stenoses resulting in competitive flow. Many issues surrounding the use of the radial artery are continuously being addressed. Many more studies were published after January 2004 on the angiographic patency of radial artery grafts, which were not included in our review article that covered through December 2003. Zacharias and associates [4] compared 6-year outcomes in a propensity-matched coronary artery bypass graft–left internal thoracic artery–left anterior descending artery (CABG–LITA–LAD) patients (925 cases), which were divided into those 
1 radial artery graft and those with only vein grafting. It was concluded that radial artery as a second arterial conduit in CABG-LITA-LAD as opposed to vein grafting improves long-term outcomes as a result of decreased late deaths, especially after postoperative year 3 [4]. However, the Radial Artery Patency and Clinical Outcome (RAPCO) study was discussed in our review [5]. The randomized comparison of the radial artery and saphenous vein coronary bypass grafts published by Desai and collegues [6] for the Radial Artery Patency Study investigators in 2004 also concluded that radial artery grafts were associated with a lower rate of graft occlusion at 1 year than with saphenous grafts. Mussa and colleagues [7] wrote an editorial on current perspectives of radial artery conduits for coronary artery bypass grafting. They stated that radial artery grafts exhibit diminished long-term patency if anastamosed to a coronary target vessel with <70% proximal stenosis [7]. We agree with Nezic and colleagues [1] and Mussa and colleagues [7] that ongoing randomized trials will establish the relative long-term patency of radial artery conduits compared with the more established internal thoracic artery and long saphenous vein.
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References
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- Nezic DG, Knezevic AM, Jovic MD, Borovic SD. Angiographic patency of the radial artery conduit in coronary artery bypass grafting (letter) Ann Thorac Surg 2006;81:1551.[Free Full Text]
- Sajja LR, Mannam G, Pantula NR, Sompalli S. Role of radial artery graft in coronary artery bypass grafting Ann Thorac Surg 2005;79:2180-2188.[Abstract/Free Full Text]
- Khot UN, Friedman DT, Petterson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts Circulation 2004;109:2086-2091.[Abstract/Free Full Text]
- Zacharias A, Habib RH, Schwann TA, Riordan CJ, Durham SJ, Shah A. Improved survival with radial artery versus vein conduits in coronary bypass survery with left internal thoracic artery to left anterior descending artery grafting Circulation 2004;109:1489-1496.[Abstract/Free Full Text]
- Buxton BF, Raman JS, Ruengsakulrach P, et al. Radial artery patency and clinical outcomesfive-year interim results of a randomized trail. J Thorac Cardiovasc Surg 2003;125:1363-1371.[Abstract/Free Full Text]
- Desai ND, Cohen EA, Naylor CD, Fremes SE. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts N Eng J Med 2004;22:2302-2309.
- Mussa S, Choudhar BP, Taggart DP. Radial artery conduits for coronary artery bypass graftingcurrent perspective. Editorial. J Thorac Cardiovasc Surg 2005;129:30-33.
Related Article
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Angiographic Patency of the Radial Artery Conduit in Coronary Artery Bypass Grafting
- Dusko G. Nezic, Aleksandar M. Knezevic, Miomir Dj. Jovic, and Sasa D. Borovic
Ann. Thorac. Surg. 2006 81: 1551.
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