title: Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy: role of arterial versus vein conduits.
abstract: BACKGROUND
  Coronary artery bypass grafting with concomitant coronary endarterectomy (CABG/CE) is used in patients with severe coronary atherosclerosis to revascularize otherwise ungraftable targets. This study investigates the efficacy of arterial versus vein grafting for CABG/CE surgery.
  
  
  METHODS
  We reviewed our experience in 288 CABG/CE patients (63 +/- 10 years, 207 men). A total of 1,056 grafts (275 internal thoracic artery [ITA] [26%]; 221 radial [21%], 560 vein [53%]) were constructed including 325 (31%) placed to CE targets.
  
  
  RESULTS
  Eighteen of 288 patients died in-hospital (6.3%). Unadjusted one-year and five-year survival for the 270 discharged patients was 95.2% and 83.0%, respectively. Survival (0 to 7 years) was significantly better for patients with radial (n = 154) versus no-radial (n = 134) artery grafting (p = 0.021). Multivariate Cox regression analysis associated increased number of arterial grafts (hazard ratio [HR] = 0.64 [0.44 to 0.92]; HR [95% confidence interval]) to improved survival, while RCA endarterectomy (HR = 1.8 1.0 3.3; p = 0.054) was associated with worse survival. Repeat angiography (495 days [median]) in 68 patients encompassed 78 CE (38 vein, 24 ITA, and 16 radial) and 162 non-CE (84 vein, 40 ITA, and 38 radial) grafts. Graft failure was similar (p = 0.37) for radial (10 of 54 [19%]) and ITA (7 of 64 [11%]), and worst for vein (50 of 122 [41%]; p < 0.001). For CE targets, graft failure was worse for vein (55% vs 35%; p = 0.05) and unchanged for arterial (13% vs 15%; p = 0.88) grafts.
  
  
  CONCLUSIONS
  Combined CABG/CE is associated with good long-term outcomes. Increased arterial grafting achieved by radial artery utilization confers a survival benefit in this high-risk population. The latter is probably derived from superior radial versus vein graft patency.
authors.affiliation: Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schwann
authors.forename: Anoar
authors.initials: A
authors.lastname: Zacharias
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Riordan
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Durham
authors.forename: Aamir S
authors.initials: AS
authors.lastname: Shah
authors.forename: Robert H
authors.initials: RH
authors.lastname: Habib
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017534:Radial Artery / Q000637:transplantation; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation