Document Detail


Radial artery conduits improve long-term survival after coronary artery bypass grafting.
MedLine Citation:
PMID:  20868808     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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.
Affiliation:
Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, New York 10003, USA. rtranbau@chpnet.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass / methods,  mortality*
Female
Humans
Kaplan-Meiers Estimate
Male
Mammary Arteries / transplantation
Middle Aged
Propensity Score
Radial Artery / transplantation*
Retrospective Studies
Saphenous Vein / transplantation
Tissue and Organ Harvesting / methods
Treatment Outcome
Vascular Patency
Comments/Corrections
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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