Invited commentary

Abstract

Doctor Iacò and colleagues evaluated long-term results of radial artery grafts (RA) in 164 patients undergoing coronary artery bypass surgery (CABG) over an 8-year period. The patients were observed for early and late mortality, incidence of reintervention, return of cardiac events, and graft patency. Attachment for inflow is of course required for RA grafts and the authors compared 36 patients with aortic inflow connection with 128 patients with the free RA being anastomosed to the attached internal thoracic artery (ITA). The RA was only anastomosed to coronary arteries of reasonable size with greater than 70% stenosis supplying an area of myocardium without ischemic damage and with high run off.Early mortality of 1.8% and survival at 8 years of 83.2% is very commendable. 37.2% of the patients had angiography of their bypass grafts within 90 days of their operation and 51.1% had late graft visualization at a mean of 48 months. Patency in the RA and IMA were statistically similar in the early group of patients restudied (88 of 89 RA vs 82 of 82 IMA) as well as the later group (87 of 91 RA vs 93 of 93 IMA). The authors concluded that the proximal anastomotic site of the RA had minimal affect on clinical or angiographic results.Besides precise methods of technique and injury free harvesting and dilatation with papaverine careful selection of coronary artery target vessels appears to be essential for achieving excellent graft patency like the authors have reported. Competition of flow has been reported to occur when target coronary artery obstruction is less than 80% if the RA has its inflow connection to the IMA and less than 60% when the RA is anastomosed to the ascending aorta. In contrast patency in the free IMA is better when it is connected to an attached IMA instead of the ascending aorta. Flow in IMA coronary artery grafts diminishes as the degree of obstruction becomes less. The authors have clearly demonstrated that when the free RA graft is employed in multiple or all arterial conduit revascularization survival, need for reintervention and patency equals that achieved with IMA grafts when the target coronary is ideal. Which free graft should be selected for the many less than ideal diseased coronary arteries that require revascularization? Will the RA equal the IMA in these situations? Doctor Iacò and colleagues evaluated long-term results of radial artery grafts (RA) in 164 patients undergoing coronary artery bypass surgery (CABG) over an 8-year period. The patients were observed for early and late mortality, incidence of reintervention, return of cardiac events, and graft patency. Attachment for inflow is of course required for RA grafts and the authors compared 36 patients with aortic inflow connection with 128 patients with the free RA being anastomosed to the attached internal thoracic artery (ITA). The RA was only anastomosed to coronary arteries of reasonable size with greater than 70% stenosis supplying an area of myocardium without ischemic damage and with high run off. Early mortality of 1.8% and survival at 8 years of 83.2% is very commendable. 37.2% of the patients had angiography of their bypass grafts within 90 days of their operation and 51.1% had late graft visualization at a mean of 48 months. Patency in the RA and IMA were statistically similar in the early group of patients restudied (88 of 89 RA vs 82 of 82 IMA) as well as the later group (87 of 91 RA vs 93 of 93 IMA). The authors concluded that the proximal anastomotic site of the RA had minimal affect on clinical or angiographic results. Besides precise methods of technique and injury free harvesting and dilatation with papaverine careful selection of coronary artery target vessels appears to be essential for achieving excellent graft patency like the authors have reported. Competition of flow has been reported to occur when target coronary artery obstruction is less than 80% if the RA has its inflow connection to the IMA and less than 60% when the RA is anastomosed to the ascending aorta. In contrast patency in the free IMA is better when it is connected to an attached IMA instead of the ascending aorta. Flow in IMA coronary artery grafts diminishes as the degree of obstruction becomes less. The authors have clearly demonstrated that when the free RA graft is employed in multiple or all arterial conduit revascularization survival, need for reintervention and patency equals that achieved with IMA grafts when the target coronary is ideal. Which free graft should be selected for the many less than ideal diseased coronary arteries that require revascularization? Will the RA equal the IMA in these situations?