Document Detail

Radial artery conduits improve long-term survival after coronary artery bypass grafting.
MedLine Citation:
PMID:  20868808     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). METHODS: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. RESULTS: Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001). CONCLUSIONS: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.
Robert F Tranbaugh; Kamellia R Dimitrova; Patricia Friedmann; Charles M Geller; Loren J Harris; Paul Stelzer; Bertram Cohen; Darryl M Hoffman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2010-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1165-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, New York 10003, USA.
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MeSH Terms
Coronary Artery Bypass / methods,  mortality*
Kaplan-Meiers Estimate
Mammary Arteries / transplantation
Middle Aged
Propensity Score
Radial Artery / transplantation*
Retrospective Studies
Saphenous Vein / transplantation
Tissue and Organ Harvesting / methods
Treatment Outcome
Vascular Patency
Comment In:
Ann Thorac Surg. 2010 Oct;90(4):1172   [PMID:  20868809 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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