Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Comparison of Radial Artery and Saphenous Vein Composite Y Grafts during Off-pump Coronary Artery Bypass

  • Wi, Jin-Hong (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Joo, Hyun-Chel (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Youn, Young-Nam (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Song, Suk-Won (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kim, Tae Hoon (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Yoo, Kyung-Jong (Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2012.11.08
  • Accepted : 2013.03.07
  • Published : 2013.08.05
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Abstract

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

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References

  1. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1-6. https://doi.org/10.1056/NEJM198601023140101
  2. Lemma M, Mangini A, Gelpi G, Innorta A, Spina A, Antona C. Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft. Eur J Cardiothorac Surg 2004;26:110-7. https://doi.org/10.1016/j.ejcts.2004.03.020
  3. Muneretto C, Negri A, Manfredi J, et al. Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation. J Thorac Cardiovasc Surg 2003;125:826-35. https://doi.org/10.1067/mtc.2003.154
  4. Cho KR, Hwang HY, Kang WJ, Lee DS, Kim KB. Progressive improvement of myocardial perfusion after off-pump revascularization with bilateral internal thoracic arteries: comparison of early versus 1-year postoperative myocardial single photon emission computed tomography. J Thorac Cardiovasc Surg 2007;133:52-7. https://doi.org/10.1016/j.jtcvs.2006.09.014
  5. Pevni D, Hertz I, Medalion B, et al. Angiographic evidence for reduced graft patency due to competitive flow in composite arterial T-grafts. J Thorac Cardiovasc Surg 2007;133: 1220-5. https://doi.org/10.1016/j.jtcvs.2006.07.060
  6. Gaudino M, Alessandrini F, Pragliola C, et al. Composite Y internal thoracic artery-saphenous vein grafts: short-term angiographic results and vasoreactive profile. J Thorac Cardiovasc Surg 2004;127:1139-44. https://doi.org/10.1016/j.jtcvs.2003.07.051
  7. Bittner HB, Savitt MA, Ching PV, Ward HB. Off-pump coronary artery revascularization: ideal indication for patients with porcelain aorta and calcification of great vessels. J Cardiovasc Surg (Torino) 2003;44:217-21.
  8. Fukushima S, Kobayashi J, Niwaya K, Tagusari O, Bando K, Nakajima H. Accelerated graft disease in a composite saphenous vein with internal thoracic artery in a chronic renal dialysis patient. Jpn J Thorac Cardiovasc Surg 2004;52:372-4. https://doi.org/10.1007/s11748-004-0013-3
  9. Glineur D, Boodhwani M, Poncelet A, et al. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries. J Thorac Cardiovasc Surg 2010;140:639-45. https://doi.org/10.1016/j.jtcvs.2009.11.013
  10. Joo HC, Youn YN, Yi G, Chang BC, Yoo KJ. Off-pump bilateral internal thoracic artery grafting in right internal thoracic artery to right coronary system. Ann Thorac Surg 2012;94:717-24. https://doi.org/10.1016/j.athoracsur.2012.04.066
  11. Kim KB, Cho KR, Chang WI, Lim C, Ham BM, Kim YL. Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts. Ann Thorac Surg 2002;74:S1371-6. https://doi.org/10.1016/S0003-4975(02)03974-7
  12. Royse AG, Royse CF, Raman JS. Exclusive Y graft operation for multivessel coronary revascularization. Ann Thorac Surg 1999;68:1612-8. https://doi.org/10.1016/S0003-4975(99)00676-1
  13. Royse AG, Royse CF, Groves KL, Bus B, Yu G. Blood flow in composite arterial grafts and effect of native coronary flow. Ann Thorac Surg 1999;68:1619-22. https://doi.org/10.1016/S0003-4975(99)00862-0
  14. Cho KR, Jeong DS, Kim KB. Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg 2007;32:718-23. https://doi.org/10.1016/j.ejcts.2007.08.001
  15. Mills NL, Everson CT. Atherosclerosis of the ascending aorta and coronary artery bypass. Pathology, clinical correlates, and operative management. J Thorac Cardiovasc Surg 1991;102:546-53.
  16. Dietl CA, Madigan NP, Laubach CA, et al. Myocardial revascularization using the "no-touch" technique, with mild systemic hypothermia, in patients with a calcified ascending aorta. J Cardiovasc Surg (Torino) 1995;36:39-44.
  17. Murphy DA, Hatcher CR Jr. Coronary revascularization in the presence of ascending aortic calcification: use of an internal mammary artery-saphenous vein composite graft. J Thorac Cardiovasc Surg 1984;87:789-91.
  18. Brodman R, Robinson G. Internal mammary artery-saphenous vein composite conduit: an alternative for the proximal coronary anastomosis. Ann Thorac Surg 1981;31:370-2. https://doi.org/10.1016/S0003-4975(10)60970-8
  19. Hayward PA, Hare DL, Gordon I, Buxton BF. Effect of radial artery or saphenous vein conduit for the second graft on 6-year clinical outcome after coronary artery bypass grafting: results of a randomised trial. Eur J Cardiothorac Surg 2008;34:113-7. https://doi.org/10.1016/j.ejcts.2008.03.027

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