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J Thorac Cardiovasc Surg 1998;116:981-989
© 1998 Mosby, Inc.
SURGERY FOR ADULT CARDIOVASCULAR DISEASE |
From the Department of Cardiovascular Surgery, Hôpital Bichat and Hôpital Broussais, Paris.
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 4-7, 1997.
Received for publication May 6, 1998. Revisions requested June 17, 1998; revisions Received July 14, 1998. Accepted for publication Aug 6, 1998. Address for reprints: Christophe Acar, MD, Chirurgie Cardiovasculaire, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.
Objective: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting.
Methods: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 ± 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 ± 1.40 years).
Results: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery.
Conclusion: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.
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