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J Thorac Cardiovasc Surg 2004;127:179-184
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Left internal thoracic artery–radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: A prospective randomized evaluation

^a Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
^b Division of Cardiology, University of Brescia Medical School, Brescia, Italy
^c Division of Cardiothoracic Surgery, Columbia University, Presbyterian Medical Center, New York, NY, USA

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication May 2, 2003; revisions received August 6, 2003; accepted for publication August 11, 2003.

^* Address for reprints: Claudio Muneretto, MD, UDA Cardiochirurgia-Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia, Italy
munerett{at}master.cci.unibs.it

OBJECTIVES: The technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients.

METHODS: We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization. Patients were assigned at random to group 1, 80 patients undergoing total arterial revascularization (left internal thoracic artery on left anterior descending coronary artery plus radial artery), or group 2, 80 patients undergoing standard coronary artery bypass graft surgery (left internal thoracic artery on left anterior descending coronary artery plus saphenous veins). The radial artery was used in all cases as a composite Y-graft.

RESULTS: Preoperative characteristics and risk factors (EuroSCORE: group 1 = 7.9 vs group 2 = 8.1), number of grafted coronary vessels (group 1 = 2.4 vs group 2 = 2.5), aortic crossclamping time (group 1 = 37 ± 7 minutes vs group 2 = 38 ± 7 minutes), ventilation time (group 1 = 22 ± 12 hours vs group 2 = 23 ± 11 hours), intensive care unit stay (group 1 = 39 ± 10 hours vs group 2 = 40 ± 9 hours), and hospital mortality (group 1 = 3.8% vs group 2 = 5%) were comparable between the groups. Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 (group 1 = 0 patients vs group 2 = 4 patients, 5%). At a mean follow-up of 16 ± 3 months, patients in group 1 showed superior clinical results with a lower incidence of graft occlusion (group 1 = 2 vs group 2 = 11; P = .06) and angina recurrence (group 1 = 2 patients vs group 2 = 12 patients; P = .03). Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence.

CONCLUSIONS: Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events.

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