Comparison Between Saphenous Vein Graft and Radial Artery Graft in Coronary Artery Bypass Grafting

Abstract

Background: To bypass the obstruction in native coronary arteries both arterial and venous grafts are used. Inspite of having radial artery graft as a favored second conduit for bypass, venous grafts are more frequently used. Objective: To compare the CT angiography patency findings of radial artery graft vs. saphenous vein graft 3 months postoperatively. Study Design: Randomized controlled trial. Settings: The study was conductedat the Department of Cardiac Surgery, Mayo Hospital, Lahore. Data Collection: All patients fulfilling theinclusioncriteria were recruited. A written informed consentwastaken. The non-dominant arm was used almostexclusively forharvesting the radial artery in those patients who have positive modified Allen`s test as a pedicle by atraumatic "no-touch" technique. After heparanization, it was immersed in diluted solution (Inj. verapamil hydrochloride 5mg + Inj. nitroglycerin 2.5mg + Inj. heparin 500 IU + Inj. ringer lactate 300 ml with Inj. 8.4% NaHCO3 0.9 m1). All the patients in the study received LIMA to LAD and were done on pump. After that the patients were dividedinto2 groups namely Group I and Group II by computer generated method. In Group I, the patient received the radial artery as a second graft to a coronary having more than 90% stenosis. The third or fourth graft if required is saphenous vein graft. The group II had SVG as second, third or fourth grafts, one of the venous grafts were to a coronary having more than 90% stenosis. Results: Average age of all (n=62) patients was 38.82±9.93 years. Average age in Group-I & II patients was 39.09±9.49 & 38.54±10.50 years respectively. Among patients 47% were male and 53% were female patients. In Group-I, 12 (38.7%) of the patients were male, and 19 (67.3%) were female, whereas in Group-II, 17 (54.8%) of the patients were male, and 14 (45.8%) were female. In Group-I 1(3.2%) patient and in Group-II 3(9.7%) patients died (p=0.301). Insignificant difference was seen for cardiac arrhythmias i.e. Group-I:16.1% vs. Group-II: 19.4%, p=0.740. Myocardial infarction in Group-A 5(16.1%) patients and in Group-B 7(22.6%) (p=0.520). In Group-A, 30(96.8%) patients and in Group-B, 28(90.3%) patients showed patency of artery after coronary artery bypass grafting(P>0.05). Conclusion: We discovered no significant difference in the patency of both radial artery and saphenous vein grafts on 3 months postoperative CT angiography and clinical outcomes in terms of perioperative mortality, MI, and cardiac arrhythmias in patients who underwent CABG in this study. Keywords: radial artery graft, saphenous vein graft, coronary artery bypass grafting, Myocardial Infarction, Mortality, Cardiac arrhythmias