Is a third arterial conduit necessary? Comparison of the radial artery and saphenous vein in patients receiving bilateral internal thoracic arteries for triple vessel coronary disease†

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
William Y ShiB F Buxton

Abstract

The use of bilateral internal thoracic arteries (BITAs) is associated with improved long-term survival after coronary artery bypass grafting (CABG). However, it is unclear whether the addition of a radial artery (RA) in patients already receiving BITA confers any additional survival benefit over that of a saphenous vein (SV). As such, we reviewed our multicentre experience and compared both strategies. From 1995 to 2010, 1497 patients underwent primary isolated CABG for three-vessel coronary disease using BITAs. An SV was used as a third conduit in 460 (31%) patients and an RA in 1037 (69%). A total of 1258 distal anastomoses were performed using RAs and these were to the diagonal territory in 169, the circumflex in 454 and the right coronary in 635. Survival data were obtained using the National Death Index and propensity-score matching was used for risk-adjustment. The overall cohort was young (mean age 61 ± 9 years). Patients receiving RAs were more likely to be younger, and were less likely to have experienced a prior myocardial infarction. At 30 days, mortality was similar (BITA + SV: 5, 1.1% vs BITA + RA: 9, 0.9%, P = 0.77). At 15 years, BITA + RA patients experienced improved unadjusted survival (BITA + SV: 67 ± 4.6% vs ...Continue Reading

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Citations

Jun 9, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Chaim LockerAmir Lerman
Oct 4, 2017·Circulation·Stuart J HeadJohn D Puskas
Aug 11, 2017·Current Opinion in Cardiology·Bobby YanagawaJohn D Puskas
Apr 16, 2020·Journal of Cardiac Surgery·Gianluca TorregrossaHusam H Balkhy
Mar 30, 2018·Frontiers in Cardiovascular Medicine·Matthijs Steven Ruiter, Maurizio Pesce
Jan 15, 2020·Circulation·Mario GaudinoUNKNOWN ATLANTIC (Arterial Grafting International Consortium) Alliance members
Aug 11, 2017·General Thoracic and Cardiovascular Surgery·Thierry Carrel, Bernhard Winkler
Jan 17, 2019·Interactive Cardiovascular and Thoracic Surgery·Sho AkitaAkihiko Usui
Jan 17, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Michele Di MauroMario Gaudino
Oct 6, 2020·Circulation·Brian F BuxtonUNKNOWN RAPCO Investigators*
Dec 1, 2018·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·James Tatoulis
Feb 19, 2021·Seminars in Thoracic and Cardiovascular Surgery·Olivier J L JegadenJoel Lapeze
Dec 24, 2018·The Journal of Thoracic and Cardiovascular Surgery·Bastien ProvostEric Bezon
Feb 2, 2020·The Journal of Thoracic and Cardiovascular Surgery·Joshua Michael RosenblumWilliam Brent Keeling
Feb 19, 2019·The Journal of Thoracic and Cardiovascular Surgery·Giuseppe TavillaHein Putter
Sep 1, 2021·The Journal of Thoracic and Cardiovascular Surgery·Francesco FormicaFrancesco Nicolini

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