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J Thorac Cardiovasc Surg 2002;123:225-231
© 2002 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CSP) |
From the Department of Cardiology and Cardiac Surgery, University "G. D'Annunzio," Chieti, Italy.
Received for publication May 15, 2001. Revisions requested July 11, 2001; revisions received Aug 2, 2001. Accepted for publication Aug 3, 2001. Address for reprints: Antonio Maria Calafiore, MD, "G. D'Annunzio" University, Division of Cardiac Surgery, c/o S. Camillo de' Lellis Hospital, via C. Forlanini, 50 66100 Chieti Italy (E-mail: calafiore@ unich.it).
Objective: We sought to evaluate whether the radial artery provides the same results as the right internal thoracic artery in lateral wall revascularization in the long term.
Methods: From January 1992 to September 1996, 288 patients had myocardial revascularization with the left internal thoracic artery anastomosed to the left anterior descending coronary artery. The lateral wall was grafted with the radial artery in 139 patients (group A) and with the right internal thoracic artery in 149 patients (group B). Groups were different only because of older age and a higher incidence of patients requiring urgent treatment in group A. Y grafting was used in 86.4% of patients in group A and in 34.8% of patients in group B (P < .001). Anastomoses per patient were similar in both groups (3.2 ± 0.8 vs 3.2 ± 0.9, P = 1.000).
Results: Thirty-day mortality was similar (2.1% vs 2.0%, P = .722). There were 15 late deaths in group A versus 11 in group B (P = .418). Cause of death was cardiac related in 6 patients in group A versus 7 in group B. Late redo or percutaneous transluminal coronary angioplasty was performed in 3 patients in group A and in 1 patient in group B (P = 0.538). Eight-year survival was 86.7% ± 2.9% in group A versus 89.6% ± 2.8% in group B (P = .477); event-free survival was 84.2% ± 3.2% versus 88.9% ± 2.9%, respectively (P = .430). The patency rate within 30 days was 99.1% in group A (105/106 left internal thoracic artery plus radial artery anastomoses) versus 100% in group B (52/52 bilateral internal thoracic artery anastomoses; P = .715). After a mean of 35 ± 28 months, the patency rate was 99.0% in group A (100/101 left internal thoracic artery plus radial artery anastomoses) and 100% in group B (33/33 bilateral internal thoracic artery anastomoses, P = .560).
Conclusion: In the long-term, lateral wall grafting with the radial artery provides the same clinical and angiographic results as right internal thoracic artery grafting.
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