Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, New York 10003, USA.
Ann Thorac Surg. 2010 Oct;90(4):1165-72. doi: 10.1016/j.athoracsur.2010.05.038.
The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV).
We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index.
Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001).
Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.
冠状动脉旁路移植术（CABG）的第二佳移植物尚不清楚。我们旨在确定使用第二条动脉移植物，桡动脉（RA），是否会在使用左内乳动脉（LITA）和大隐静脉（SV）进行 CABG 后改善长期生存。
我们比较了使用 LITA、RA 和 SV 进行的孤立、原发性 CABG 与仅使用 LITA 和 SV 进行的 CABG 的患者在倾向性匹配后 14 年的结果。每组各有 826 名患者，其倾向性匹配的人口统计学和多个变量相似。主要终点是使用社会安全死亡索引获得的全因死亡率。
包括住院死亡率（RA 患者为 0.1%，SV 患者为 0.2%）在内的围手术期结果相似。RA 组的 1、5 和 10 年 Kaplan-Meier 生存率分别为 98.3%、93.9%和 83.1%，SV 组分别为 97.2%、88.7%和 74.3%（对数秩检验，p=0.0011）。Cox 比例风险模型显示 RA 组的全因死亡率较低（风险比 0.72，置信区间：0.56 至 0.92，p=0.0084）。10 年生存率显示 SV 患者的死亡率增加了 52%（25.7%），而 RA 患者的死亡率为 16.9%（p=0.0011）。对于有症状的患者，RA 通畅率为 80.7%，与 LITA 通畅率 86.4%没有差异，但优于 SV 通畅率 46.7%（p<0.001）。
与仅使用 LITA 和 SV 相比，使用 LITA、SV 和 RA 移植物进行 CABG 可显著改善长期生存。使用两条动脉移植物可提供明显且持久的生存优势，这可能归因于 RA 移植物的通畅性提高。我们得出结论，RA 移植物在 CABG 中应更广泛地应用。
