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Short- and long-term results of radial artery and saphenous vein grafts in the right coronary system: a propensity-matched study

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Abstract

Purpose

The selection of optimal grafts for the right coronary artery remains controversial. This study aims to evaluate the short- and long-term results of radial artery (RA) grafts and saphenous vein grafts (SVGs) to the right coronary artery.

Methods

We reviewed, retrospectively, isolated coronary artery bypass grafts, placed between 1997 and 2007, and compared the long-term results of patients who received RA (n = 110) grafts with those of patients who received SVGs (n = 264) using propensity-score matching for risk. The preoperative predictors of graft occlusion were investigated on a per case basis.

Results

Superior survival was noted in the unmatched RA group, but late outcomes after propensity-score matching yielded 91 patient pairs that were similar in the two groups. Graft failure was not correlated with mortality, but showed strong correlation with cardiac events in all patients. The predictors of graft occlusion in the RA group were mild proximal stenosis and low indexing glomerular filtration rates for body surface area, whereas those in the SVG were female gender and off-pump coronary artery bypass grafting.

Conclusions

There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.

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References

  1. Buxton BF, Komeda M, Fuller JA, Gordon I. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgery. Risk-adjusted survival. Circulation. 1998; 98:II1–6.

  2. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358:870–5.

    Article  CAS  PubMed  Google Scholar 

  3. Burfeind WR, Glower DD, Wechsler AS, Tuttle RH, Shaw LK, Harrell FE, et al. Single versus multiple internal mammary artery grafting for coronary artery bypass 15-year follow-up of a clinical practice trial. Circulation. 2004; 110:II-27–II-35.

  4. Rankin JS, Tuttle RH, Wechsler AS, Teichmann TL, Glower DD, Califf RM. Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. The Annals of thoracic surgery. 2007; 83:1008–14 (discussion 14–5).

  5. Esaki J, Koshiji T, Okamoto M, Tsukashita M, Ikuno T, Sakata R. Gastroepiploic artery grafting does not improve the late outcome in patients with bilateral internal thoracic artery grafting. Ann Thorac Surg. 2007;83:1024–9.

    Article  PubMed  Google Scholar 

  6. Lev-Ran O, Mohr R, Uretzky G, Pevni D, Locker C, Paz Y, et al. Graft of choice to right coronary system in left-sided bilateral internal thoracic artery grafting. Ann Thorac Surg. 2003;75:88–92.

    Article  PubMed  Google Scholar 

  7. Mekontso-Dessap A, Kirsch M, Guignambert C, Zadigue P, Adnot S, Loisance D, et al. Vascular-wall remodeling of 3 human bypass vessels: organ culture and smooth muscle cell properties. J Thorac Cardiovasc Surg. 2006;131:651–8.

    Article  PubMed  Google Scholar 

  8. Ikeda M, Ohashi H, Tsutsumi Y, Hige K, Kawai T, Ohnaka M. Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency. Eur J Cardiothorac Surg. 2002;21:800–3.

    Article  PubMed  Google Scholar 

  9. Georghiou GP, Vidne BA, Dunning J. Does the radial artery provide better long-term patency than the saphenous vein? Interact CardioVasc Thorac Surg. 2005;4:304–10.

    Article  PubMed  Google Scholar 

  10. Gaudino M, Alessandrini F, Pragliola C, Cellini C, Glieca F, Luciani N, et al. Effect of target artery location and severity of stenosis on mid-term patency of aorta-anastomosed vs. internal thoracic artery-anastomosed radial artery grafts. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2004;25:424–8.

    Article  Google Scholar 

  11. Cameron J, Trivedi S, Stafford G, Bett JH. Five-year angiographic patency of radial artery bypass grafts. Circulation. 2004; 110:II23–6.

  12. Deb S, Cohen EA, Singh SK, Une D, Laupacis A, Fremes SE. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (radial artery patency study). J Am Coll Cardiol. 2012;60:28–35.

    Article  PubMed  Google Scholar 

  13. Maniar HS, Barner HB, Bailey MS, Prasad SM, Moon MR, Pasque MK, et al. Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann Thorac Surg. 2003; 76:1498–503 (discussion 503–4).

  14. Desai ND, Cohen EA, Naylor CD, Fremes SE. Radial Artery Patency Study I. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med. 2004;351:2302–9.

    Article  CAS  PubMed  Google Scholar 

  15. Delanaye P, Mariat C, Cavalier E, Krzesinski J-M. Errors induced by indexing glomerular filtration rate for body surface area: reductio ad absurdum. Nephrol Dial Transpl. 2009;24:3593–6.

    Article  Google Scholar 

  16. Imai E, Horio M, Nitta K, Yamagata K, Iseki K, Tsukamoto Y, et al. Modification of the Modification of Diet in Renal Disease (MDRD) Study equation for Japan. Am J Kidney Dis Off J Natl Kidney Found. 2007;50:927–37.

    Article  Google Scholar 

  17. Schwann TA, Al-Shaar L, Engoren M, Habib RH. Late effects of radial artery vs saphenous vein grafting for multivessel coronary bypass surgery in diabetics: a propensity-matched analysis. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2013;44:701–10.

    Article  Google Scholar 

  18. Deb S, Singh SK, Moussa F, Tsubota H, Une D, Kiss A, et al. The long-term impact of diabetes on graft patency after coronary artery bypass grafting surgery: A substudy of the multicenter Radial Artery Patency Study. J Thorac Cardiovasc Surg. 2014;148:1246–53.

    Article  PubMed  Google Scholar 

  19. Zhang H, Wang Z, Wu H, Hu X, Zhou Z, Xu P. Radial artery graft vs. saphenous vein graft for coronary artery bypass surgery. Herz. 2014;39:458–65.

    Article  CAS  PubMed  Google Scholar 

  20. Zhang B, Zhou J, Li H, Liu Z, Chen A, Zhao Q. Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: an updated meta-analysis. Ann Thorac Surg. 2014;97:1335–41.

    Article  PubMed  Google Scholar 

  21. Tomoaki S, Tohru A. The current status of multi-arterial off-pump coronary artery bypass grafting. Surg Today. 2016;46:1–12.

    Article  PubMed  Google Scholar 

  22. Yamamoto M, Orihashi K, Nishimori H, Handa T, Kondo N, Fukutomi T, et al. Efficacy of intraoperative HyperEye Medical System angiography for coronary artery bypass grafting. Surg Today. 2015;45:966–72.

    Article  PubMed  Google Scholar 

  23. Kurlansky PA, Traad EA, Galbut DL, Singer S, Zucker M. Ebra EdD G. Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women. Ann Thorac Surg. 2002;74:1517–25.

    Article  PubMed  Google Scholar 

  24. Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg. 1998;66:125–31.

    Article  CAS  PubMed  Google Scholar 

  25. Abramov D, Tamariz MG, Sever JY, Christakis GT, Bhatnagar G, Heenan AL, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg. 2000;70:800–5.

    Article  CAS  PubMed  Google Scholar 

  26. Kinoshita T, Asai T, Suzuki T, Van Phung D. Histomorphology of right versus left internal thoracic artery and risk factors for intimal hyperplasia. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2014;45:726–31.

    Article  Google Scholar 

  27. Raitoharju E, Lyytikäinen L-P, Levula M, Oksala N, Mennander A, Tarkka M, et al. miR-21, miR-210, miR-34a, and miR-146a/b are up-regulated in human atherosclerotic plaques in the tampere vascular study. Atherosclerosis. 2011;219:211–7.

    Article  CAS  PubMed  Google Scholar 

  28. Tagusari O, Kobayashi J, Bando K, Niwaya K, Nakajima H, Ishida M, et al. Early adaptation of the left internal thoracic artery as a blood source of y-composite radial artery grafts in off-pump coronary artery bypass grafting. Heart Surg Forum. 2003;6:E93–8.

    PubMed  Google Scholar 

  29. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the international brachial artery reactivity task force. J Am Coll Cardiol. 2002;39:257–65.

    Article  PubMed  Google Scholar 

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Acknowledgments

I express my sincere appreciation to Dr. Satoshi Kainuma, whose enormous support and insightful comments were invaluable during the course of my study.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui, 910-0833, Japan

    Shohei Yoshida, Satoshi Numata, Yasushi Tsutsumi, Osamu Monta, Sachiko Yamazaki, Hiroyuki Seo, Takaaki Samura & Hirokazu Ohashi

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  1. Shohei Yoshida
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  2. Satoshi Numata
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  3. Yasushi Tsutsumi
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Correspondence to Satoshi Numata.

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Shohei Yoshida and his co-authors have no conflicts of interest.

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Yoshida, S., Numata, S., Tsutsumi, Y. et al. Short- and long-term results of radial artery and saphenous vein grafts in the right coronary system: a propensity-matched study. Surg Today 47, 335–343 (2017). https://doi.org/10.1007/s00595-016-1396-3

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  • DOI: https://doi.org/10.1007/s00595-016-1396-3

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