Radial artery conduits improve long-term survival after coronary artery bypass grafting.
BACKGROUND
The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV).


METHODS
We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index.


RESULTS
Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001).


CONCLUSIONS
Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.
Tranbaugh
Robert F
RF
Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, New York 10003, USA. rtranbau@chpnet.org
Dimitrova
Kamellia R
KR
Friedmann
Patricia
P
Geller
Charles M
CM
Harris
Loren J
LJ
Stelzer
Paul
P
Cohen
Bertram
B
Hoffman
Darryl M
DM
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency