Division of Cardiac Surgery, Beth Israel Medical Center, First Ave at 16 St, New York, NY 10003, USA.
Circulation. 2012 Sep 11;126(11 Suppl 1):S170-5. doi: 10.1161/CIRCULATIONAHA.111.083048.
Radial artery (RA) grafts are an attractive second arterial conduit after the left internal thoracic artery (LITA) for coronary artery bypass graft (CABG) surgery. However, long-term outcomes and the need for subsequent reintervention have not been defined.
We performed a retrospective cohort study of our single institution's 16-year experience with 1851 consecutive patients (average age, 58 years; 82% men, 36% diabetic) undergoing primary, isolated CABG with the LITA, RA, and saphenous vein as needed. Average grafts per patient were 3.8, with 2.4 arterial grafts per patient. Survival was determined using the Social Security Death Index. Grafts were nonpatent if they had a >50% stenosis, a string sign, or were occluded. Five patients (0.3%) died in hospital and 0.8% had a myocardial infarction, 1.1% a stroke, and 0.6% renal failure. Kaplan-Meier-estimated 1-, 5-, 10-, and 15-year survival was 99%, 96%, 89%, and 75%, respectively. Of the cohort, 278 symptomatic patients underwent cardiac catheterization at our institution an average of 5.0±3.8 years (range, 0.1-12 years) after CABG. Overall RA (n=420 grafts) patency was 82% and SV (n=364 grafts) patency, 47% (P<0.0001). LITA (n=287 grafts including 9 sequential grafts) patency was 85% and right internal thoracic artery (n=15 grafts) patency was 80% (P=0.6). RA patency was not different from LITA patency (P=0.3). Overall freedom from catheterization, percutaneous coronary intervention, and CABG was 85%, 97%, and 99%, respectively.
RA grafting is a highly effective revascularization strategy providing excellent short and long-term outcomes with very low rates of reintervention. RA patency is similar to LITA patency and is much better than SV patency. RA grafting should be more widely utilized in patients undergoing CABG.
桡动脉（RA）移植物是左内乳动脉（LITA）后进行冠状动脉旁路移植（CABG）手术的另一种有吸引力的动脉第二移植物。然而，长期结果和后续再介入的需要尚未确定。
我们对单中心 16 年的 1851 例连续患者进行了回顾性队列研究，这些患者平均年龄为 58 岁，82%为男性，36%为糖尿病患者，接受了原发性、孤立性 CABG，需要时使用 LITA、RA 和隐静脉。每位患者的平均移植物为 3.8 个，每位患者有 2.4 个动脉移植物。使用社会保障死亡指数确定生存率。如果存在 >50%狭窄、线样征或闭塞，则认为移植物不通。5 例（0.3%）患者在医院死亡，0.8%发生心肌梗死，1.1%发生卒中和 0.6%发生肾衰竭。Kaplan-Meier 估计的 1、5、10 和 15 年生存率分别为 99%、96%、89%和 75%。在该队列中，278 例有症状患者在 CABG 后平均 5.0±3.8 年（范围 0.1-12 年）在我们的机构接受了心脏导管检查。整体 RA（n=420 个移植物）通畅率为 82%，SV（n=364 个移植物）通畅率为 47%（P<0.0001）。LITA（n=287 个移植物，包括 9 个连续移植物）通畅率为 85%，右内乳动脉（n=15 个移植物）通畅率为 80%（P=0.6）。RA 通畅率与 LITA 通畅率无差异（P=0.3）。总体免于导管检查、经皮冠状动脉介入治疗和 CABG 的生存率分别为 85%、97%和 99%。
RA 移植是一种非常有效的血运重建策略，提供了出色的短期和长期结果，再介入率非常低。RA 通畅率与 LITA 相似，远优于 SV 通畅率。RA 移植应更广泛地应用于接受 CABG 的患者。
