title: Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft.
abstract: OBJECTIVE
  We sought to evaluate whether the radial artery (RA) provides the same clinical and angiographic results when proximally anastomosed to the aorta or to the left internal thoracic artery (ITA) as a composite Y-graft.
  
  
  METHODS
  From February 1999 to December 2002, 512 patients underwent myocardial revascularization using the RA, the left ITA and, when required, the saphenous vein. According to the surgeons' preference the RA was proximally anastomosed to the aorta [336 patients (65.6%), Ao-Cor group] or to the left ITA as a composite Y-graft [176 patients (34.4%), Y-graft group]. There was a significant prevalence of three-vessel disease (86.8 versus 73.2%, (P = 0.000) and elderly age (60+/-9 versus 58+/-8 years, (P = 0.014) in the Y-graft group.
  
  
  RESULTS
  Patients in Y-graft group had longer aortic cross clamp time (P = 0.001), more bypass grafts per patient (P < or = 0.001) more arterial bypass grafts per patient (P < or = 0.001) and more bypass grafts per patient with the RA (P < or = 0.001). There were no differences in terms of perioperative outcome. Mean follow-up time was 27.1+/-11.7 months in 322/333 (96.7%) patients of the Ao-Cor group and 14.9+/-10.2 in 165/172 (95.9%) patients of the Y-graft group. There was no difference in terms of overall survival (P = 0.75) cardiac event-free survival (P = 0.65) RA patency rate at postoperative angiography (P = 0.59) and during follow-up (P = 0.93). A preoperative coronary artery stenosis < or = 70% was related with competitive flow (P = 0.000) at postoperative angiography and with RA occlusion (P = 0.001) at follow-up angiography.
  
  
  CONCLUSIONS
  The RA provides the same clinical and angiographic results both as aorto-coronary and composite Y-graft with the left ITA. When the RA is used as Y-graft the procedure is more technically demanding and a greater number of distal coronary anastomoses is possible. RA grafts to targets with stenosis < or = 70% appear to be at risk of failure.
authors.affiliation: Division of Cardiovascular Surgery 'L. Sacco Hospital', Via G.B. Grassi 74, 20157 Milan, Italy. massimo.lemma@fastwebnet.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Lemma
authors.forename: Andrea
authors.initials: A
authors.lastname: Mangini
authors.forename: Guido
authors.initials: G
authors.lastname: Gelpi
authors.forename: Andrea
authors.initials: A
authors.lastname: Innorta
authors.forename: Amedeo
authors.initials: A
authors.lastname: Spina
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D016019:Survival Analysis; D014654:Vascular Patency