Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting With Preferred Use of the Radial Artery

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Abstract
Background: The use of the radial artery (RA) for coronary artery bypass grafting (CABG) is still not widely accepted. The purpose of this study was to evaluate the impact of preferred RA utilization on clinical outcomes. Methods: Data on 138 consecutive patients undergoing CABG using the RA (in addition to the internal mammary artery) were prospectively collected and compared to 228 patients undergoing CABG without the RA. Results: The mean age was 56 ± 10 years (range 29 to 79 years). Preoperatively 91% (126/138) were in CCS angina Class III/IV, 45% (66/138) were nonelective, and 14% (20/138) were reoperations. An average of 3.5 ± 0.9 grafts per patient were performed, of which 2.5 ± 0.5 (71%) were arterial. The RA was used for single distal vessel in 103 patients, for sequential grafting in 35, and overall for 1.3 distal targets per patient. There were no perioperative deaths, reoperation for bleeding, Ml, or CVA. Six patients (4%) had minor RA harvest‐related complications. The length of hospital stay was 5.6 ± 3.1 days. Hospital outcomes were similar to a cohort of patients undergoing CABG without RA. Mean follow‐up for 99% (137/138) of patients was 7.1 ± 4.3 months (range 1 to 18 months). Long‐term major complications included one sudden death (0.7%) and three Mls (2.2%). At the time of follow‐up, 95% (131/137) were in CCS angina Class I/II. Routine thallium stress test performed in 93 patients showed normal perfusion in 98%. There were no long‐term major vascular or neurological deficits related to RA harvest. Conclusions: The use of RA in patients undergoing CABG is safe and effective. These excellent early clinical outcomes justify liberal use of the RA, although long‐term follow‐up is required to establish its ultimate role as a preferred conduit.