Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery composite grafting.

摘要

OBJECTIVE: The radial artery is frequently the second graft of choice after the left internal thoracic artery in coronary artery bypass graft surgery. However, the optimal radial artery proximal anastomosis site remains controversial. The aim of the present study was to compare the radial artery patency according to its use as either an aorta-radial artery graft or composite radial artery graft in coronary artery bypass grafting. METHODS: A total of 1735 patients received coronary artery bypass grafting using the radial artery between January 2001 and July 2007, of whom 893 received serial computed tomographic coronary angiographies; these patients formed the basis of the current study. The patients were divided into 2 groups: group I (direct radial artery to aortic anastomosis, n = 451 patients) and group II (radial artery composite grafting with the left internal thoracic artery, n = 442 patients). The number of distal radial artery anastomoses performed in group I was 657 and 749 in group II. Sequential bypassing was performed in 399 patients. RESULTS: The early patency rate was significantly higher in group I than in group II (98.3% vs 94.5%; P = .004). The 1-, 2-, and 5-year patency rates were also higher in group I than in group II (93.8% +/- 1.2%, 90.5% +/- 1.6%, and 74.3% +/- 6.1%, vs 90.5% +/- 1.4%, 85.3% +/- 1.9%, and 65.2% +/- 4.2%, respectively; P = .004). Multivariate analysis showed composite grafting (P = .02), the degree of target vessel stenosis <90% (P = .001), and the target revascularization site (P = .005) to be significant risk factors for occlusion. CONCLUSION: The results of the current data showed superior early and late patency rates of coronary artery bypass grafting with radial artery to aorta anastomosis compared with left internal thoracic artery-radial artery composite grafting.