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J Thorac Cardiovasc Surg 2005;130:1227
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Radial artery for coronary artery bypass grafting

Cardiovascular Surgery, Catholic University Hospital, Marcoleta 367, Santiago, Chile

To the Editor:

I would like to comment on a recent editorial by Mussa and colleagues ¹ regarding radial artery grafts for coronary artery bypass grafting. In their review of vasospasm prophylaxis, they state that in addition to antispasmodic agents during harvesting, oral calcium-channel antagonists have been recommended for as long as 1 year after surgery to prevent delayed vasospasm. However, my coworkers and I ² recently reported a study evaluating the effects of calcium-channel blockers in two randomized groups of comparable patients. We found no differences between patients who received diltiazem and those who did not, especially regarding the development of vascular spasm and angiographic patency 1 year after surgery. Similar results have been published by other authors. ^3,4

This evidence is relevant when we consider widespread use of the radial artery for myocardial revascularization in patients with different types of coronary disease. Antispasmodic agents are known to have adverse consequences, for example, in patients with acute hemodynamic instability or with poor left ventricular function.

I agree with Mussa and colleagues ¹ when they state that there is accumulating evidence that grafting the radial artery to coronary targets with moderate stenosis (<70%) results in reduced patency. Angiographic evidence from our study, with a reproducible and objective method, demonstrated that the degree of native coronary stenosis was a strong predictor of radial artery patency (P = .00001; odds ratio 1.08). When the degree of stenosis in the native coronary artery is 70% or more, the radial artery graft patency approaches that of the internal thoracic artery at 1 postoperative year. ²

I postulate that there is sufficient evidence with which to recommend the use of radial artery grafts for myocardial revascularization in patients with significant coronary artery stenosis (<70%). Topical antispasmodic agents should be used only during harvesting the conduit. There is no need for intravenous or oral calcium-channel blockers, either intraoperatively or during the first year of follow-up.

The definitive place of the radial artery compared with other conduits for coronary grafting will have to await the outcome of ongoing randomized trials.

References

1. Mussa S, Choudhary B, Taggart D. Radial artery conduits for coronary artery bypass grafting. current perspective. J Thorac Cardiovasc Surg 2005;129:250-253.[Free Full Text]
   
2. Moran S, Baeza R, Guarda E, Zalaquett R, Irarrazaval M, Marchant E, et al. Predictors of radial artery patency for coronary bypass operations. Ann Thorac Surg 2001;72:1552-1556.[Abstract/Free Full Text]
   
3. Acar C, Ramsheyi A, Pagni JY, Jebara V, Barrier P, Fabiani JN, et al. The radial artery for coronary artery bypass grafting. clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998;116:981-989.[Abstract/Free Full Text]
   
4. Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C, et al. Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. J Thorac Cardiovasc Surg 1998;116:1015-1021.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moran, S. V. Search for Related Content PubMed PubMed Citation Articles by Moran, S. V. Related Collections Related Article