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The second best arterial graft to the left coronary system in off-pump bypass surgery: a propensity analysis of the radial artery with a proximal anastomosis to the ascending aorta versus the right internal thoracic artery

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Abstract

Objective

The second best arterial graft to the left coronary artery (LCA) system between the radial artery (RA) and the right internal thoracic artery (RITA) has been unknown. Moreover, a composite RA may be inferior to direct aorta-RA bypass grafting. The aim of the present study is to compare clinical outcomes between the RA anastomosed to the aorta and the RITA as a second arterial graft to the LCA.

Methods

A total of 805 patients received off-pump coronary arterial bypass grafting between 2000 and 2013. Of these patients, 232 received the bilateral internal thoracic arteries (BITA) and 152 received left internal thoracic arteries (LITA) + RA anastomosed to the aorta, following the inclusion criteria. Patients (1) received at least two arterial grafts in the LCA, (2) did not have renal insufficiency, and (3) did not receive composite RA grafts. A propensity score-matched analysis was performed, resulting in 118 matched pairs.

Results

There was no difference in operative mortality and stroke rate between the matched groups; however, the mean operation time was significantly shorter in the LITA + RA and the incidence of mediastinitis was lower in the LITA + RA (BITA: 2.5 %, LITA + RA: 0 %, p < 0.01). Kaplan–Meier cumulative mortality and freedom from cardiac events were similar. The long-term patency rates of the RITA and the RA were similar at 5 years (RITA: 78 %, RA: 84 %, p = 0.55).

Conclusions

The RA anastomosed to the aorta appears to have good long-term outcomes, similar to the RITA as the second arterial graft. Furthermore, the choice of RA avoids sternal complications and shortens the operation time compared to the use of BITA.

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References

  1. Kieser TM, Curran HJ, Rose MS, Norris CM, Graham MM. Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98 % arterial grafts. J Thorac Cardiovasc Surg. 2014;147:75–83.

    Article  PubMed  Google Scholar 

  2. Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, et al. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J. 2010;20:2470–81.

    Article  Google Scholar 

  3. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. Circulation. 2011;124:e652–735.

    Article  PubMed  Google Scholar 

  4. Jung SH, Song H, Choo SJ, Je HG, Chung CH, Kang JW, et al. Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery grafting. J Thorac Cardiovasc Surg. 2009;138:76–83.

    Article  PubMed  Google Scholar 

  5. Lee SH, Chung CH, Jung SH, Lee JW, Choo SJ. Midterm results of beating heart coronary bypass surgery for non-left internal thoracic artery anastomosis according to grafting design and implications of intraoperative flow characteristics on graft patency. Thorac Cardiovasc Surg. 2012;60:438–45.

    Article  PubMed  Google Scholar 

  6. Tranbaugh RF, Dimitrova KR, Lucido DJ, Hoffman DM, Dincheva GR, Geller CM, et al. The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery. J Thorac Cardiovasc Surg. 2014;147:133–40.

    Article  PubMed  Google Scholar 

  7. Navia D, Vrancic M, Piccinini F, Camporrotondo M, Thierer J, Gil C, et al. Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score–matched follow-up study. J Thorac Cardiovasc Surg. 2014;147:632–8.

    Article  PubMed  Google Scholar 

  8. Hayward PA, Hare DL, Gordon I, Matalanis G, Buxton BF. Which arterial conduit? Radial artery versus free right internal thoracic artery: six-year clinical results of a randomized controlled trial. Ann Thorac Surg. 2007;84:493–7.

    Article  PubMed  Google Scholar 

  9. Caputo M, Reeves B, Marchetto G, Mahesh B, Lim K, Angelini GD. Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes. J Thorac Cardiovasc Surg. 2003;126:39–47.

    Article  PubMed  Google Scholar 

  10. Ruttmann E, Fischler N, Sakic A, Chevtchik O, Alber H, Schistek R, et al. Second internal thoracic artery versus radial artery in coronary artery bypass grafting: a long-term, propensity score-matched follow-up study. Circulation. 2011;124:1321–9.

    Article  PubMed  Google Scholar 

  11. Hoffman DM, Dimitrova KR, Lucido DJ, Dincheva GR, Geller CM, Balaram SK, et al. Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries. Ann Thorac Surg. 2014;98:30–6.

    Article  PubMed  Google Scholar 

  12. Saso S, James D, Vecht JA, Kidher E, Kokotsakis J, Malinovski V, et al. Effect of skeletonization of the internal thoracic artery for coronary revascularisation on the incidence of sternal wound infection. Ann Thorac Surg. 2010;89:661–70.

    Article  PubMed  Google Scholar 

  13. Kamiya H, Akhyari P, Martens A, Karck M, Haverich A, Lichtenberg A. Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: a randomized study. J Thorac Cardiovasc Surg. 2008;135:32–7.

    Article  PubMed  Google Scholar 

  14. Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, et al. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improved sternal perfusion after coronary artery bypass surgery. A randomized, double-blind, within-patient comparison. Circulation. 2006;114:766–73.

    Article  PubMed  Google Scholar 

  15. Manabe S, Fukui T, Shimokawa T, Tabata M, Katayama Y, Morita S, et al. Increased graft occlusion or string sign in composite arterial grafting for mildly stenosed target vessels. Ann Thorac Surg. 2010;89:683–8.

    Article  PubMed  Google Scholar 

  16. Pevni D, Hertz I, Medalion B, Kramer A, Paz Y, Uretzky G, 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.

    Article  PubMed  Google Scholar 

  17. Maniar HS, Barner HB, Bailey MS, Prasad SM, Moon MR, Pasque MK, et al. Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann Thorac Surg. 2003;76:1498–503.

    Article  PubMed  Google Scholar 

  18. Mussa S, Choudhary BP, Taggart DP. Radial artery conduits for coronary artery bypass grafting: current perspective. J Thorac Cardiovasc Surg. 2005;129:250–3.

    Article  PubMed  Google Scholar 

  19. Tsuneyoshi H, Komiya T, Shimamoto T, Sakai J, Hiraoka T, Kawashima T, et al. Efficacy of partial clamp during off-pump coronary artery bypass grafting. J Jpn Coron Assoc. 2014. doi:10.7793/jcoron.20.14-00018.

  20. Emmert MY, Seifert B, Wilhelm M, Grünenfelder J, Falk V, Salzberg SP. Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011;142:1499–506.

    Article  PubMed  Google Scholar 

  21. Lev-Ran O, Loberman D, Matsa M, Pevni D, Nesher N, Mohr R, et al. Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann Thorac Surg. 2004;77:102–7.

    Article  PubMed  Google Scholar 

  22. Yamaguchi A, Adachi H, Tanaka M. Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. Ann Thorac Cardiovasc Surg. 2009;15:98–104.

    PubMed  Google Scholar 

  23. Daniel WT 3rd, Kilgo P, Puskas JD. Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes. J Thorac Cardiovasc Surg. 2014;147:2097–100.

    Google Scholar 

  24. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011. Gen Thorac Cardiovasc Surg. 2013;61:578–607.

    Article  PubMed  Google Scholar 

  25. Elbardissi AW, Aranki SF, Sheng S, O’Brien SM, Greenberg CC, Gammie JS. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg. 2012;143:273–81.

    Article  PubMed  Google Scholar 

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All the authors have declared no competing interest.

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Correspondence to Hiroshi Tsuneyoshi.

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Tsuneyoshi, H., Komiya, T., Shimamoto, T. et al. The second best arterial graft to the left coronary system in off-pump bypass surgery: a propensity analysis of the radial artery with a proximal anastomosis to the ascending aorta versus the right internal thoracic artery. Gen Thorac Cardiovasc Surg 63, 335–342 (2015). https://doi.org/10.1007/s11748-015-0534-y

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  • DOI: https://doi.org/10.1007/s11748-015-0534-y

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