J Thorac Cardiovasc Surg 2005;130:232-233
© 2005 The American Association for Thoracic Surgery
Radial artery conduits in coronary artery bypass grafting: Current perspective
Anoar Zacharias, MD
a
,
c
,
Robert H. Habib, PhD
a
,
b
,
Thomas A. Schwann, MD
a
,
c
,
Christopher J. Riordan, MD
a
,
c
,
Samuel J. Durham, MD
a
,
c
,
Aamir Shah, MD
a
,
c
a Division of Cardiovascular Surgery, St Vincent Mercy Medical Center, Toledo, Ohio
b Department of Medicine, Medical College of Ohio, Toledo, Ohio
c Department of Surgery, Medical College of Ohio, Toledo, Ohio
To the Editor:
We read with great interest the recent article by Mussa and colleagues.
1
Their update article providing a current perspective on the use of radial grafting in coronary artery bypass grafting (CABG) comes at a time of increasing evidence supporting such utilization.
2,3
We, however, wish to comment on 2 fronts. First, we concur that there is considerable interest in how radial patency compares with that of saphenous vein grafts, especially in light of the high vein failure rate compared with that of internal thoracic artery (ITA) conduits. Yet in this respect only the negative radial findings of Khot and associates
4
are discussed, albeit with a word of caution that their data are in stark contrast with those of most reports. That study, among other limitations, also reported that diabetes somehow protects against radial graft failure, and hence their data should be carefully and objectively considered. Note, 2 weeks earlier in the same journal, our group had shown the opposite findings in closely matched vein and radial patient groups.
3
There, 242 total grafts were reassessed (2-year median follow-up) in a subcohort of recatheterized symptomatic patients. Importantly, for patients receiving both types of conduits (ie, each patient served as own control), absolute radial graft failure—defined as occlusion, stenosis >90%, or string sign—was significantly less than that of vein grafts (29% vs 41%; P = .039), and the 6-year cumulative Kaplan-Meier radial patency was greater. Similar results have since been reported from the randomized prospective trial by Desai and colleagues.
2
Second, Mussa and colleagues probably agree that the ultimate goal of optimizing graft patency is improving survival. In well-matched patients undergoing CABG, all of whom received left ITA to left anterior descending coronary artery pedicle (LITA-LAD) grafts, using the radial artery as a second arterial conduit as opposed to vein resulted in improved late survival, especially after the third postoperative year (Figure 1).
3
This benefit is similar to or better than what has been reported with bilateral ITA grafting. We suggest that the radial artery is indeed the arterial conduit of second choice, at least in patients in whom the bilateral ITA is contraindicated.
References
- Mussa S, Choudhary BP, Taggart DP. Radial artery conduits for coronary artery bypass grafting. current perspective. J Thorac Cardiovasc Surg 2005;129:250-253.[Free Full Text]
- Desai ND, Cohen EA, Naylor CD, Fremes SE, Radial Artery Patency Study Investigators A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med. 2004;351:2302-2309.[Abstract/Free Full Text]
- Zacharias A, Habib RH, Schwann TA, Riordan CJ, Durham SJ, Shah A. Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting. Circulation 2004;109:1489-1496.[Abstract/Free Full Text]
- Khot UN, Friedman DT, Pettersson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared to left internal mammary arteries and saphenous vein grafts. Circulation 2004;109:2086-2091.[Abstract/Free Full Text]
- Blackstone EH, Naftel DC, Turner Jr ME. The decomposition of time-varying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc 1986;81:615-624.
