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J Thorac Cardiovasc Surg 2010;139:60-67
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years: Results from the Radial Artery Patency and Clinical Outcomes trial

^a Department of Cardiac Surgery, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
^b Statistical Consulting Centre, University of Melbourne, Parkville, Victoria, Australia
^c Department of Cardiology, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia

Received for publication May 6, 2008; revisions received September 2, 2009; accepted for publication September 28, 2009.

^_* Address for reprints: Brian F. Buxton, FRACS, FRCS, FRCS(C), Victorian Heart Centre, Epworth Hospital, Bridge Road, Richmond, Victoria, Australia. (Email: brianbuxton{at}ozemail.com.au).

Objective: To investigate the optimum conduit for coronary targets other than the left anterior descending artery, we evaluated long-term patencies and clinical outcomes of the radial artery, right internal thoracic artery, and saphenous vein through the Radial Artery Patency and Clinical Outcomes trial.

Methods: As part of a 10-year prospective, randomized, single-center trial, patients undergoing primary coronary surgery were allocated to the radial artery (n = 198) or free right internal thoracic artery (n = 196) if aged less than 70 years (group 1), or radial artery (n = 113) or saphenous vein (n = 112) if aged at least 70 years (group 2). All patients received a left internal thoracic artery to the left anterior descending, and the randomized conduit was used to graft the second largest target. Protocol-directed angiography has been performed at randomly assigned intervals, weighted toward the end of the study period. Grafts are defined as failed if there was occlusion, string sign, or greater than 80% stenosis, independently reported by 3 assessors. Analysis is by intention to treat.

Results: At mean follow up of 5.5 years, protocol angiography has been performed in groups 1 and 2 in 237 and 113 patients, respectively. There are no significant differences within each group in preoperative comorbidity, age, or urgency. Patencies were similar for either of the 2 conduits in each group (log rank analysis, P = .06 and P = .54, respectively). The differences in estimated 5-year patencies were 6.6% (radial minus right internal thoracic artery) in group 1 and 2.9% (radial minus saphenous vein graft) in group 2.

Conclusion: At mean 5-year angiography in largely asymptomatic patients, the selection of arterial or venous conduit for the second graft has not significantly affected patency. This finding offers surgeons, for now, enhanced flexibility in planning revascularization.

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