title: Impact of the Radial Artery as an Additional Arterial Conduit During In-Situ Bilateral Internal Mammary Artery Grafting: A Propensity Score-Matched Study.
abstract: BACKGROUND
  Bilateral internal mammary artery (BIMA) grafting has been associated with improved long-term outcomes after CABG. We sought to evaluate the early results and long-term survival among coronary artery bypass graft patients who underwent in-situ BIMA grafting with the radial artery (RA) as an additional arterial conduit compared with those who underwent BIMA with additional saphenous vein graft (SVG).
  
  
  METHODS
  Between 1991 and 2013, 1,750 consecutive patients with triple-vessel disease or left main plus right coronary system disease underwent primary isolated in-situ BIMA grafting with at least one internal mammary artery to the left anterior descending artery. Patients were divided into a BIMA-RA group (n = 255) and BIMA-SVG group (n = 1,495). Propensity score matching was used to create two comparable cohorts: 249 BIMA-RA patients were one-to-one-matched to 249 BIMA-SVG patients. The date of death was obtained from provincial vital statistics. The median follow-up was 8 years.
  
  
  RESULTS
  There was no difference in operative mortality between matched BIMA-RA and BIMA-SVG (0.8% versus 0.4%, respectively; p = 0.6). Five-year, 10-year, and 15-year survival rates were 98.3%, 92.0%, and 92.0%, respectively, among BIMA-RA patients, versus 96.5%, 93.0%, and 87.0% in the matched BIMA-SVG group (log rank p = 0.44). When we stratified the BIMA-RA patients into subgroups according to the severity of target artery stenosis, late survival was also similar among the BIMA-RA subgroups matched to BIMA-SVG patients (log rank p = 0.12).
  
  
  CONCLUSIONS
  The use of the RA as an additional arterial graft in patients undergoing coronary artery bypass graft surgery with in-situ BIMA does not prolong late survival when compared with BIMA patients who received additional SVG.
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada. Electronic address: siamak.mohammadi@fmed.ulaval.ca.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Charbonneau
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Marzouk
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Paramythiotis
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D057216:Propensity Score; D011792:Quebec / Q000453:epidemiology; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome