Radial artery as a second conduit gains momentum: The RAPCO trial.

Walid Simry,Ahmed Afifi

doi:10.21542/gcsp.2021.10

Abstract

In coronary artery bypass grafting (CABG), the use of an internal mammary artery (IMA) to graft the left anterior descending coronary artery (LAD) improves survival and reduces the need for repeat revascularization. The other IMA, radial artery (RA), and saphenous vein (SV) have contested to complete the surgical revascularization. For that purpose, SV remains the most commonly used conduit despite current evidence in favor of arterial grafts. To determine which conduit is best for grafting the second most important coronary artery, Buxton and colleagues have recently published the long term results of their “Radial Artery Patency and Clinical Outcomes (RAPCO)” trial.

Highlights

Coronary artery bypass grafting (CABG) surgery is the best treatment modality for ischemic heart disease (IHD) patients[1]
In the SV arm, the authors found a trend towards better 10-year patency in the radial artery (85%) versus the saphenous vein (71%) and a 10-year survival of 72.6% for the RA group versus 65.2% for the SV and no significant difference in the incidence of early complications
The Melbourne group arguably has the highest rate of radial artery usage and, the trial started 25 years ago, its recently published report comes as a welcome addition to the literature

Summary

INTRODUCTION

Coronary artery bypass grafting (CABG) surgery is the best treatment modality for ischemic heart disease (IHD) patients[1]. The use of an internal mammary artery (IMA) to graft the left anterior descending coronary artery (LAD) has long been proven to improve survival and reduce the need for repeat revascularization[2] It is not clear which is the best conduit to use for grafting the second most important coronary artery. Due to its ease of harvest and handling, the saphenous vein (SV) continues to be the most commonly used graft for the second most important coronary artery worldwide and, in spite of the mounting evidence[3], the use of arterial grafts like the radial artery (RA) and right internal mammary artery (RIMA), remains infrequent—accounting for less than 10% of cases in North America[4]. While in the RITA arm; a significant difference in 10-year patency rate in favor of the RA was found (93% versus 83%) (hazard ratio, 0.45 [95% CI [0.23–0.88]]) and survival at 10 years was 90.9% and 83.7% in the RA and RITA groups, respectively (hazard ratio, 0.53 [95% CI [0.30–0.95]])—a trend which was more pronounced in the diabetic sub-group

DISCUSSION

Findings

CONCLUSION