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Effect of the Proximal Anastomosis Configuration of the Radial Artery in Patients Undergoing Coronary Artery Bypass Grafting

윤승근, Song Hyun, Lim Ju-Yong,
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윤승근 ( Yoon Seung-Keun ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Thoracic and Cardiovascular Surgery
 ( Song Hyun ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Thoracic and Cardiovascular Surgery
 ( Lim Ju-Yong ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Thoracic and Cardiovascular Surgery

Abstract


Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG.

Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison.

Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20?0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01?5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively).

Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

키워드

Coronary artery bypass grafting; Radial artery; Vascular patency; Vascular graft occlusion; Surgical anastomosis

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