Author + information
- Received January 15, 2016
- Revision received May 2, 2016
- Accepted May 3, 2016
- Published online August 9, 2016.
- Mario Gaudino, MDa,b,∗ (, )
- Paolo Tondi, MDa,
- Umberto Benedetto, PhDc,
- Valentina Milazzo, MDa,
- Roberto Flore, MDa,
- Franco Glieca, MDa,
- Francesca Romana Ponziani, MDa,
- Nicola Luciani, MDa,
- Leonard N. Girardi, MDb,
- Filippo Crea, MDb and
- Massimo Massetti, MDb
- aDepartment of Cardiovascular Sciences, Catholic University, Rome, Italy
- bDepartment of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
- cBristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Mario Gaudino, Department of Cardiothoracic Surgery, Weill Cornell Medical College, 525 East 68th Street, New York, New York 10065.
Background There is a lack of evidence for the choice of the second conduit in coronary surgery. The radial artery (RA) is a possible option, but few data on very-long-term outcomes exist.
Objectives This study describes 20-year results of RA grafts used for coronary artery bypass grafting and the effects of RA removal on forearm circulation.
Methods We report the results of the prospective 20-year follow-up of the first 100 consecutive patients who received the RA as a coronary bypass conduit at our institution.
Results Follow-up was 100% complete. There were 64 deaths, 23 (35.9%) from cardiovascular causes. Kaplan-Meier 20-year survival was 31%. Of the 36 survivors, 33 (91.6%) underwent RA graft control at a mean of 19.0 ± 2.5 years after surgery. The RA was found to be patent in 24 cases (84.8% patency). In the overall population, probability of graft failure at 20 years was 19.0 ± 0.2% for the left internal thoracic artery (ITA), 25.0 ± 0.2% for the RA, and 55.0 ± 0.2% for the saphenous vein (p = 0.002 for RA vs. saphenous vein, 0.11 for RA vs. ITA, and p < 0.001 for ITA vs. saphenous vein). Target vessel stenosis >90%, but not location of distal anastomosis, significantly influenced long-term RA graft patency. No patients reported hand or forearm symptoms. The ulnar artery diameter was increased in the operated arm (2.44 ± 0.43 mm vs. 2.01 ± 0.47 mm; p < 0.05) and correlated with the peak systolic velocity of the second palmar digital artery (Pearson coefficient: 0.621; p < 0.05).
Conclusions The 20-year patency rate of RA grafts is good, and not inferior to the ITA, especially when the conduit is used to graft a vessel with >90% stenosis. RA harvesting does not lead to hand or forearm symptoms, even at a very-long-term follow-up.
The British Heart Foundation and the NIHR Bristol Cardiovascular Biomedical Research Unit funded The University of Bristol contribution. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Presented in part as an abstract at the American Association for Thoracic Surgery Coronary Meeting, New York, New York, August 2016.
- Received January 15, 2016.
- Revision received May 2, 2016.
- Accepted May 3, 2016.
- American College of Cardiology Foundation