Elective vs non-elective radial artery grafts: comparing midterm results through 64-Slice computed tomography.
BACKGROUND
Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of the coronary artery bypass graft procedure (CABG). This grafting in turn has led to an increased use of other arterial conduits, of which the radial artery (RA) is most popular. Whether RA grafting can be used in the emergency patient is controversial.


METHODS
47 patients with critical stenosis (>70%) in all target vessels underwent CABG with LITA and RA grafts from 1996 to 2003. Patients were divided into elective (23 patients) and non-elective groups (24 patients) with LITA and RA grafts per patient being similar in both groups. Of these 47 patients, 5 died from non-cardiac complications and 12 were unavailable. Thus, 30 patients (71% of survivors) were studied by multidetector computed tomography. A total of 36 LITA and 64 RA grafts were studied.


RESULTS
The RA patency rate for elective and non-elective grafts were 82% (31/38) and 85% (22/26), respectively (p=0.75). The RA had a similar patency rate for all target vessels ranging from 73% to 100%. Only one patient had a redo CABG and 29 (97%) are free from angina or re-intervention. LITA-LADA had a 92% (11/12) and 100% (10/10) patency rate for elective and non-elective groups, respectively (p=0.37). The sequential LITA-diagonal-LADA in the elective group had a 50% (03/06) patency rate, which was significantly lower than the 100% (08/08) patency rate of the non-elective group (p=0.02).


CONCLUSIONS
Radial Artery grafts can be used in both elective and non-elective patients with excellent results.
Rocha-e-Silva
Roberto
R
Heart Institute (InCor-HCFMUSP), University of Sao Paulo Medical School.
Santos
Tiago S G
TS
Rochite
Carlos E
CE
Rocha-Filho
José A
JA
Mansur
Antônio P
AP
Fabri
José
J
Ramos
Rogério B
RB
Dallan
Luis A O
LA
Stolf
Noedir A G
NA
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality / Q000592:standards; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000637:transplantation*; D013895:Thoracic Arteries / Q000000981:diagnostic imaging / Q000637:transplantation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency