title: The second best arterial graft to the left coronary system in off-pump bypass surgery: a propensity analysis of the radial artery with a proximal anastomosis to the ascending aorta versus the right internal thoracic artery.
abstract: OBJECTIVE
  The second best arterial graft to the left coronary artery (LCA) system between the radial artery (RA) and the right internal thoracic artery (RITA) has been unknown. Moreover, a composite RA may be inferior to direct aorta-RA bypass grafting. The aim of the present study is to compare clinical outcomes between the RA anastomosed to the aorta and the RITA as a second arterial graft to the LCA.
  
  
  METHODS
  A total of 805 patients received off-pump coronary arterial bypass grafting between 2000 and 2013. Of these patients, 232 received the bilateral internal thoracic arteries (BITA) and 152 received left internal thoracic arteries (LITA) + RA anastomosed to the aorta, following the inclusion criteria. Patients (1) received at least two arterial grafts in the LCA, (2) did not have renal insufficiency, and (3) did not receive composite RA grafts. A propensity score-matched analysis was performed, resulting in 118 matched pairs.
  
  
  RESULTS
  There was no difference in operative mortality and stroke rate between the matched groups; however, the mean operation time was significantly shorter in the LITA + RA and the incidence of mediastinitis was lower in the LITA + RA (BITA: 2.5 %, LITA + RA: 0 %, p < 0.01). Kaplan-Meier cumulative mortality and freedom from cardiac events were similar. The long-term patency rates of the RITA and the RA were similar at 5 years (RITA: 78 %, RA: 84 %, p = 0.55).
  
  
  CONCLUSIONS
  The RA anastomosed to the aorta appears to have good long-term outcomes, similar to the RITA as the second arterial graft. Furthermore, the choice of RA avoids sternal complications and shortens the operation time compared to the use of BITA.
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan, tuneyosi_ca@yahoo.co.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsuneyoshi
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamoto
authors.forename: Jiro
authors.initials: J
authors.lastname: Sakai
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hiraoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawashima
authors.forename: Genya
authors.initials: G
authors.lastname: Muraoka
authors.forename: Masato
authors.initials: M
authors.lastname: Fujimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Yamanaka
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
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