Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

Abstract

Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery (RA) gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG. From January 2000 to December 2006, 85 patients (56 male and 29 female) at a mean age of 57.0 +/- 5.2 years, underwent TAR in CABG. RA and left internal mammary artery (LIMA) with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed. Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 +/- 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92, to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One (1.2%) patient died, 3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 +/- 4.1 months (6 - 67 months). Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 +/- 0.09, compared with that of 0.43 +/- 0.11 preoperatively (P = 0.027). Postoperative mean New York Heart Association class was 2.5 +/- 0.5, compared with that of 3.0 +/- 0.4 preoperatively (P = 0.003). TAR with arterial conduits of which RA was mainly used was proved in this study to be effective and safe in CABG.