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Anoar Zacharias
Thomas A. Schwann
Christopher J. Riordan
Samuel J. Durham
Aamir S. Shah
Milo Engoren
Robert H. Habib
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J Thorac Cardiovasc Surg 2010;139:1511-1518
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery

Anoar Zacharias, MDa, Thomas A. Schwann, MDb, Christopher J. Riordan, MDb, Samuel J. Durham, MDb,c, Aamir S. Shah, MDb,c, Milo Engoren, MDb, Robert H. Habib, PhDa,d,*

a Yvonne Viens, SGM, Research Institute-Saint Vincent Mercy Medical Center, Toledo, Ohio
b Division of Cardiothoracic Surgery, the Regional Heart and Vascular Center at Saint Vincent Mercy Medical Center, Toledo, Ohio
c Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
d Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio

Received for publication March 9, 2009; revisions received July 3, 2009; accepted for publication July 29, 2009.

* Address for reprints: Robert H. Habib, PhD, Cardiovascular and Pulmonary Research, Yvonne Viens, SGM, Research Institute, St Vincent Mercy Medical Center, 2222 Cherry St, MOB2, Suite 1250, Toledo, OH 43608. (Email: Robert_Habib{at}mhsnr.org).

Objective: We investigated whether use of radial artery versus saphenous vein grafts during coronary artery bypass grafting reoperations is associated with a significant long-term survival benefit.

Methods: We reviewed a series of 347 consecutive coronary artery bypass grafting reoperations (1996–2007; 270 [78%] male patients; age, 65.3 ± 9.2 years). Internal thoracic artery grafts were used in 248 (71%) patients at the time of the first coronary artery bypass grafting operation and in 154 (44%) patients at reoperation. Patients were grouped based on whether a functional radial artery graft was present after coronary artery bypass grafting reoperation (radial artery cohort, n = 203 [59%]) or not (saphenous vein cohort, n = 144 [41%]). Median time to reoperation was similar for the radial artery (10.3 years) and saphenous vein (10.1 years) cohorts (P = .55). Angiographic data were used to ascertain the number and type of grafts that remained functional from initial coronary artery bypass grafting. Survival data (≤12 years) were time segmented based on multiphase hazard modeling at 90 days, and late survival was then analyzed by using proportional hazard Cox regression, with risk adjustment based on a radial artery–use propensity score computed from 48 covariates, including time to reoperation, month of surgical intervention, and total arterial and vein grafts after reoperation. Propensity-matched and propensity quintile comparisons were also done.

Results: Follow-up was similar for the radial artery versus saphenous vein cohorts (5.7 ± 3.4 vs 5.8 ± 4.0 years, P = .86), and 112 (50 in the radial artery and 62 in the saphenous vein cohorts) deaths were documented. Early mortality (≤90 days) did not differ for the radial artery (7.4%) and saphenous vein (12.5%) cohorts (P = .14). Unadjusted late outcomes were superior for the radial artery versus saphenous vein cohorts, with survival of 97.3% versus 92.9%, 84.9% versus 77.2%, and 74.1% versus 60.3% at 1, 5, and 10 years, respectively. Propensity-adjusted radial artery survival was superior, with a hazard ratio of 0.58 (P = .04), and this result was confirmed in a propensity-matched comparison.

Conclusions: We conclude that the use of radial artery as opposed to saphenous vein grafting for reoperative coronary artery bypass grafting, either with or without concomitant internal thoracic artery grafts, is associated with a substantial improvement in late survival. This benefit is likely derived from the increased overall number of arterial grafts.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; ITA = internal thoracic artery; LAD = left anterior descending artery; LITA = left internal thoracic artery; RA = radial artery; SV = saphenous vein


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Effect of radial artery or saphenous vein conduit as a second graft on late clinical outcome after coronary artery bypass grafting surgery
Dusko Nezic, Aleksandar Knezevic, and Slobodan Micovic
J. Thorac. Cardiovasc. Surg. 2010 140: 941. [Extract] [Full Text] [PDF]



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 J. Thorac. Cardiovasc. Surg.Home page
D. Nezic, A. Knezevic, and S. Micovic
Effect of radial artery or saphenous vein conduit as a second graft on late clinical outcome after coronary artery bypass grafting surgery
J. Thorac. Cardiovasc. Surg., October 1, 2010; 140(4): 941 - 941.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. H. Habib
Reply to the Editor
J. Thorac. Cardiovasc. Surg., October 1, 2010; 140(4): 941 - 942.
[Full Text] [PDF]


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