Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of the Proximal Anastomosis Configuration of the Radial Artery in Patients Undergoing Coronary Artery Bypass Grafting

  • Yoon, Seung Keun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lim, Ju Yong (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2020.06.24
  • Accepted : 2020.11.20
  • Published : 2021.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

Keywords

References

  1. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001-2008. JAMA 2011;305:1769-76. https://doi.org/10.1001/jama.2011.551
  2. Carrel T, Winkler B. Current trends in selection of conduits for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2017;65:549-56. https://doi.org/10.1007/s11748-017-0807-8
  3. Acar C, Jebara VA, Portoghese M, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;54:652-60. https://doi.org/10.1016/0003-4975(92)91007-V
  4. Naito Y, Shinoka T, Duncan D, et al. Vascular tissue engineering: towards the next generation vascular grafts. Adv Drug Deliv Rev 2011;63:312-23. https://doi.org/10.1016/j.addr.2011.03.001
  5. 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
  6. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019;40:87-165. https://doi.org/10.1093/eurheartj/ehy394
  7. Locker C, Schaff HV, Dearani JA, et al. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation 2012;126:1023-30. https://doi.org/10.1161/CIRCULATIONAHA.111.084624
  8. Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol 2012;60:28-35. https://doi.org/10.1016/j.jacc.2012.03.037
  9. Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med 2018;378:2069-77. https://doi.org/10.1056/NEJMoa1716026
  10. Kim DJ, Lee SH, Joo HC, Yoo KJ, Youn YN. Effect of the proximal anastomosis site on mid-term radial artery patency in off-pump coronary artery bypass. Eur J Cardiothorac Surg 2018;54:475-82. https://doi.org/10.1093/ejcts/ezy059
  11. 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
  12. Iaco AL, Teodori G, Di Giammarco G, et al. Radial artery for myocardial revascularization: long-term clinical and angiographic results. Ann Thorac Surg 2001;72:464-9. https://doi.org/10.1016/S0003-4975(01)02758-8
  13. Maniar HS, Barner HB, Bailey MS, et al. Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann Thorac Surg 2003;76:1498-504. https://doi.org/10.1016/S0003-4975(03)00758-6
  14. Sajja LR, Mannam G, Pantula NR, Sompalli S. Role of radial artery graft in coronary artery bypass grafting. Ann Thorac Surg 2005;79:2180-8. https://doi.org/10.1016/j.athoracsur.2004.07.049
  15. Maniar HS, Sundt TM, Barner HB, et al. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 2002;123:45-52. https://doi.org/10.1067/mtc.2002.118686
  16. Mussa S, Choudhary BP, Taggart DP. Radial artery conduits for coronary artery bypass grafting: current perspective. J Thorac Cardiovasc Surg 2005;129:250-3. https://doi.org/10.1016/j.jtcvs.2004.07.040
  17. Calafiore AM, Teodori G, Di Giammarco G, et al. Coronary revascularization with the radial artery: new interest for an old conduit. J Card Surg 1995;10:140-6. https://doi.org/10.1111/j.1540-8191.1995.tb01232.x
  18. Jung SH, Song H, Choo SJ, et al. Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery composite grafting. J Thorac Cardiovasc Surg 2009;138:76-83. https://doi.org/10.1016/j.jtcvs.2008.12.004
  19. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996;28:616-26. https://doi.org/10.1016/0735-1097(96)00206-9
  20. Cameron J, Trivedi S, Stafford G, Bett JH. Five-year angiographic patency of radial artery bypass grafts. Circulation 2004;110(11 Suppl 1):II23-6.
  21. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-45. https://doi.org/10.1093/ejcts/ezs043
  22. Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007;116:471-9. https://doi.org/10.1161/CIRCULATIONAHA.106.653501
  23. LaPar DJ, Hawkins RB, McMurry TL, et al. Preoperative anemia versus blood transfusion: which is the culprit for worse outcomes in cardiac surgery? J Thorac Cardiovasc Surg 2018;156:66-74. https://doi.org/10.1016/j.jtcvs.2018.03.109