Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization

Abstract

Objective: The long-term benefits of multiple arterial revascularization (MAR) in coronary artery bypass grafting remain uncertain. The aim of this study was to investigate the clinical outcome, graft patency, and need for subsequent target revascularization of radial artery (RA) versus saphenous vein graft in patients undergoing MAR in both patient-and graft-specific analyses.Methods: Between 2001 and 2016, we followed 1654 patients over a median of 7.4 years in a prospective, longitudinal study. Major adverse cardiac and cerebrovascular events, graft patency, and need for revascularization were assessed through clinical manifestation, coronary angiography, or coronary computed tomography and analyzed with propensity score-adjusted Cox regression, general estimating equation, and competing risk models.Results: Bilateral internal thoracic artery (BITA) grafting was performed in 910 patients (55.0%), and 744 patients (45.0%) received a left internal thoracic artery graft together with at least 1 RA graft. Patients receiving BITA, of whom 187 received an additional RA, showed improved survival (hazard ratio, 0.57; 95% confidence interval [CI], 0.38-0.86; P ¼ .009), major adverse cardiac and cerebrovascular event-free survival (hazard ratio, 0.33; 95% CI, 0.23-0.46; P<.001), and lower need for repeat revascularization (subhzhard ratio, 0.59; 95% CI, 0.39-0.90; P ¼ .015). In a subgroup of 512 patients, comparing 419 RA with 487 saphenous vein grafts, RA grafting showed a lower risk for graft occlusion (odds ratio, 0.59; 95% CI, 0.47-0.73; P<.001) and target revascularization (subhazard ratio, 0.58; 95% CI, 0.43-0.78; P <.001).Conclusions: MAR with BITA and RA grafting revealed to be the recommended strategy in coronary artery bypass grafting to achieve long-term beneficial results. The use of saphenous vein graft showed less favorable outcomes regarding patency and the need for target-vessel revascularization. (J Thorac Cardiovasc Surg 2019;158:442-50) 0.8 0.6 0.4 0.2 0.0 0 3 6 9 Years after CABG Cumulative incidence (revascularization) 12 15 Radial artery Saphenous vein graftNeed for subsequent target-vessel revascularization of radial artery versus saphenous vein grafts. Central MessageThe merits of radial artery over saphenous vein grafting in CABG are clearly demonstrated in this long-term follow-up study.Perspective MAR with BITA and RA grafting revealed to be the recommended strategy in CABG to achieve long-term beneficial results. The use of SVG showed less-favorable outcomes regarding long-term patency and the need for target-vessel revascularization.

How decisive is the number of distal arterial anastomoses in coronary bypass surgery?

“…However, GEA use is not very popular despite the good outcome observed in several studies [17,18]. Ruttmann E [19]. for RADIAL investigators has reported better survival and outcome regarding patency and the need for target-vessel revascularization of the radial artery graft in comparison with saphenous vein graft; we have had no experience with radial artery grafting and it was never used in this series because we have privileged in situ grafts.…”

How decisive is the number of distal arterial anastomoses in coronary bypass surgery ?

“…However, GEA use is not very popular despite the good outcome observed in several studies [17,18]. Ruttmann E. [19] for RADIAL investigators has reported better survival and outcome regarding patency and the need for target-vessel revascularization of the radial artery graft in comparison with saphenous vein graft; we have had no experience with radial artery grafting and it was never used in this series because we have privileged in situ grafts . We did not test if the impact of ITA anastomosis and GEA anastomosis could be different, rst because such evaluation is not appropriate without concomitant study of the patency and second because the target vessels were de nitively different; however the contribution of sequential ITA graft was found determinant, underlying the bene t of additional bypass targets revascularized with an ITA.…”

How decisive is the number of distal arterial anastomoses in coronary bypass surgery?

“…However, GEA use is not very popular despite the good outcome observed in several studies [17,18]. Ruttmann E. [19] for RADIAL investigators has reported better survival and outcome regarding patency and the need for targetvessel revascularization of the radial artery graft in comparison with saphenous vein graft; we have had no experience with radial artery grafting and it was never used in this series because we have privileged in situ grafts. We did not test if the impact of ITA anastomosis and GEA anastomosis could be different, rst because such evaluation is not appropriate without concomitant study of the patency and second because the target vessels were de nitively different; however the contribution of sequential ITA graft was found determinant, underlying the bene t of additional bypass targets revascularized with an ITA.…”