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J Thorac Cardiovasc Surg 2005;130:233
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Reply to the Editor:

Shafi Mussa, MA, MRCS, Bikram P. Choudhary, MRCS, David P. Taggart, MD(Hons), PhD, FRCS

Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom

We thank Zacharias and colleagues for their interest in our article concerning current perspectives in radial artery (RA) use as coronary bypass conduits. 1 Go Their letter raises 2 important issues: (1) comparative patency of RA versus saphenous vein graft conduits and (2) the effect of using RA grafts on survival after coronary bypass surgery.

Concerning the issue of RA versus saphenous vein graft patency, the excellent midterm graft patency rates taken from the symptomatic subgroup reported by Zacharias and colleagues 2 Go merely give an indication of graft durability but do not provide definitive information with respect to long-term patency. We are fortunate that prospective, randomized controlled trials specifically are currently addressing this question. Recently, Desai and associates 3 Go reported data from the largest of these trials, the Radial Artery Patency Study (RAPS), and found a significant difference in favor of RA angiographic patency 1 year after the operation. Buxton’s group has reported results from a much smaller cohort, part of the Radial Artery Patency and Clinical Outcome (RAPCO) trial, 4 Go suggesting no significant difference in angiographic patency between RA and saphenous vein grafts. Forthcoming midterm and long-term patency data from these groups should resolve this important issue.

The effect of RA grafts on survival after CABG has yet to be elucidated in the context of a controlled trial to address the second point. The 8-year time-to-event analysis of propensity-matched groups from Zacharias and colleagues 2 Go provides encouraging preliminary support for the thesis that RA conduits might translate to improved clinical outcomes. Again, a definitive answer awaits analysis of long-term clinical outcome data from the ongoing randomized trials. 4 Go

The best evidence to date, both in terms of conduit patency 5 Go and survival, 6 Go suggests that the optimal strategy for CABG in most cases is the use of bilateral internal thoracic arteries. The RA, if used in optimal fashion, is probably the conduit of choice if a third graft is required or if bilateral internal thoracic artery grafting is contraindicated.

References

  1. 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]
  2. Zacharias A, Habib RH, Schwann TA, et al. 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]
  3. Desai ND, Cohen EA, Naylor CD, Fremes SE. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med 2004;351:2302-2309.[Abstract/Free Full Text]
  4. Buxton BF, Raman JS, Ruengsakulrach P, et al. Radial artery patency and clinical outcomes: five-year interim results of a randomized trial. J Thorac Cardiovasc Surg 2003;125:1363-1371.[Abstract/Free Full Text]
  5. Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation 2001;104:2164-2170.[Abstract/Free Full Text]
  6. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001;358:870-875.[Medline]

Related Article

Reply to the Editor:
Shafi Mussa, Bikram P. Choudhary, and David P. Taggart
J. Thorac. Cardiovasc. Surg. 2005 130: 233. [Extract] [Full Text] [PDF]




This Article
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Shafi Mussa
David P. Taggart
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