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Eur J Cardiothorac Surg 2005;27:870-875
© 2005 Elsevier Science NL
a Department of Cardiac Surgery, Austin Hospital, Melbourne, Vic., Australia
b Statistical Consulting Centre, University of Melbourne, Parkville, Vic., Australia
c University of Melbourne, Department of Cardiology, Austin Hospital, Melbourne, Vic., Australia
d Epworth Medical Centre, Melbourne, Vic., Australia
Received 23 November 2004; received in revised form 21 December 2004; accepted 3 January 2005.
* Corresponding author. Address: Austin Health, Studley Road, Heidelberg, Melbourne, Vic. 3084, Australia. Tel.: +61 3 9496 5453; fax: +61 3 9459 6220. (E-mail: brian.buxton{at}austin.org.au).
Objective: The right internal thoracic artery is being used infrequently despite favorable observational angiographic data. Conversely, the radial artery utilization has increased with only limited data available. The purpose of this paper is to re-evaluate the roles of the right internal thoracic artery and the radial artery grafts. Methods: We reviewed all ischemia-directed coronary angiographic procedures from January 1996 to December 2003. A total of 219 patients had primary coronary artery bypass grafting with an internal thoracic artery and a radial artery as two of the bypass grafts. Six hundred and seventy-nine (679) graft angiograms (45 saphenous vein, 363 radial artery, 54 right internal thoracic artery and 217 left internal thoracic artery) were studied. The mean period from operation to re-angiogram was 1104±761 days. Angiographic outcomes were divided into groups as: (1) patent (<50% stenosis) or (2) failed (
50% stenosis, string sign or occluded). A generalized linear mixed model was used to analyze predictors of graft patency. Turnbull's estimates of cumulative patency were used to compare graft failure rates over time. Results: A total of 632/679 (93%) grafts were patent and 47/679 (7%) grafts had failed. Empirical saphenous vein graft patency was 40/45 (89%), radial artery patency 329/363 (91%), right internal thoracic artery patency 51/54 (94%) and left internal thoracic artery patency 212/217 (98%). Pairwise comparisons of patency from the generalized linear mixed model were: LITA>RITA, OR=1.5 (P=0.5); LITA>RA, OR=5.7 (P<0.001); LITA>SV, OR=6.5 (P<0.001); RITA>RA, OR=3.9 (P=0.01); RITA>SV, OR=4.4 (P=0.01); RA>SV, OR=1.1 (P=0.7). Five-year patency estimates from the Turnbull's model were the left internal thoracic artery (95.9%), right internal thoracic artery (91.2%), the radial artery (90.6%) and the saphenous vein (81.8%). Conclusions: Consideration should be given to the routine use of both internal thoracic arteries for coronary artery bypass grafting. When additional grafts are required, there is no evidence to suggest that either the radial artery or saphenous vein is superior.
Key Words: CABG • Radial artery • Internal thoracic artery • Saphenous vein • Conduits
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