Document Detail


Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes.
MedLine Citation:
PMID:  12878937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We sought to compare early and midterm clinical outcomes in patients receiving a right internal thoracic artery or a radial artery as the second arterial conduit for myocardial revascularization. METHODS: Data prospectively collected for all patients who underwent coronary artery bypass surgery between April 1996 and May 2001 and who received both a left internal thoracic artery graft and either a right internal thoracic artery (n = 336) or a radial artery graft (n = 325) were analyzed. Patients in the radial artery group were older, with a greater body mass index, poorer ejection fraction, greater prevalence of diabetes, and higher New York Heart Association class than those in the right internal thoracic artery group. RESULTS: Odds ratios for perioperative myocardial infarction, atrial fibrillation, postoperative transfusion, and intensive care unit stay all showed a statistically significant benefit in the radial artery group compared with results in the right internal thoracic artery group (P <or=.05). Survival estimates at 18 months for patients who received right internal thoracic artery and radial artery grafts were 98.4% and 99.7%, respectively (hazard ratio, 0.25; 95% confidence interval, 0.06-1.10; P =.07). Estimates for survival free from any cardiac-related event or death in the right internal thoracic artery and radial artery groups were 92.3% and 97.8%, respectively (hazard ratio, 0.37; 95% confidence interval, 0.16-0.84; P =.02). A multivariate Cox regression model showed a stronger protective effect of a radial artery graft (hazard ratio, 0.25; 95% confidence interval, 0.12-0.51; P <.0001). CONCLUSION: Early and midterm outcomes of myocardial revascularization with 2 arterial grafts are better if the radial artery is used for the second graft rather than the right internal thoracic artery, assuming that the left internal thoracic artery is used for the first arterial graft.
Authors:
Massimo Caputo; Barnaby Reeves; Giovanni Marchetto; Balakrishnan Mahesh; Kelvin Lim; Gianni D Angelini
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  126     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-24     Completed Date:  2003-09-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-47     Citation Subset:  AIM; IM    
Affiliation:
Bristol Heart Institute, Bristol Royal Infirmary, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cause of Death
Coronary Artery Bypass / mortality
Coronary Disease / diagnosis,  epidemiology,  surgery
Disease-Free Survival
Female
Follow-Up Studies
Great Britain
Humans
Length of Stay
Male
Mammary Arteries / surgery*
Middle Aged
Multivariate Analysis
Myocardial Revascularization*
Prognosis
Radial Artery / surgery*
Risk Factors
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2003 Jul;126(1):5-6   [PMID:  12878932 ]
J Thorac Cardiovasc Surg. 2004 Mar;127(3):893-4; author reply 894-5   [PMID:  15043071 ]

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


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