Reappraisal of a 20-year experience with the radial artery as a conduit for coronary bypass grafting

Abstract

This study aimed at evaluating the clinical and angiographic results of the radial artery (RA) used as a coronary bypass graft over 20 years. Clinical follow-up was obtained in 563 patients at 9.2 years. Angiographic follow-up was obtained in 351 patients with opacification of 1427 conduits, including 629 RA at 7.0 years. At 9.2 years, freedom from overall and cardiovascular death was 80.3% and 92.7%, respectively. Symptoms were: acute myocardial infarction: 2.1% (n = 12); angina: 17.4% (n = 98), and congestive heart failure 10.6% (n = 60). Percutaneous revascularization was required in 13.5% (n = 76) of cases on: native coronary (n = 77), RA conduit (n = 21), and other graft (n = 7). Reoperation was needed in 2.3% (n = 13) of cases for valve replacement (n = 10) and redo coronary artery bypass grafting (CABG) (n = 3). At 7.0 years, RA patency was 82.8% (521/629) and was lower than that of left internal mammary artery (IMA), 95.5% (491/514) ( p < 0.001); similar to right IMA, 87.9% (51/58, p = 0.32); free IMA, 80.0% (44/55, p = 0.60); and vein, 81.9% (140/171, p = 0.77). RA patency was lower in the case of myocardial ischemia: 74.0% (174/235) versus 88.1% (347/394) in asymptomatics ( p < 0.001). RA patency was higher for diagonal (93.1% (95/102)) compared to circumflex (82.5% (274/332, p < 0.01)) and right coronary (77.6% (146/188, p < 0.001)). Calcium channel blockers had no impact on RA patency. Separating four groups at successive follow-up intervals, RA patency was: 86.2%, 81.9%, 81.4%, and 81.6% at 1.0, 5.4, 8.3, and 13.1 years, respectively. CABG with the RA offered long-lasting clinical benefit. Beyond the first postoperative year during which some attrition was observed, RA patency was remarkably stable for up to 20 years.