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Effect of the proximal anastomosis site on mid-term radial artery patency in off-pump coronary artery bypass

Authors
Kim, DJ; Lee, SH; Joo, HC; Yoo, KJ; Youn, YN
Citation
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 54(3):475-482, 2018
Journal Title
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
ISSN
1010-79401873-734X
Abstract
OBJECTIVES: The purpose of this study was to evaluate mid-term patency and clinical outcomes according to the proximal anastomosis site after off-pump coronary artery bypass using the radial artery (RA).
METHODS: From January 2001 to December 2015, 1124 patients who underwent isolated off-pump coronary artery bypass using the RA were reviewed and divided into 2 groups: the composite Y-graft (n = 1014, Y group) and aortocoronary graft (n = 110, Aorta group). Graft patency was assessed by computed tomography or coronary angiography.
RESULTS: Patients receiving Y-grafts had a greater number of RA anastomoses (1.79 ± 0.68 per patient vs 1.40 ± 0.51 per patient, P < 0.001), more sequential grafts (55.6% vs 37.3%, P < 0.001) and a higher incidence of total arterial revascularization (77.9% vs 54.5%, P < 0.001). Postoperative graft patency at a mean of 3.1 ± 3.5 years was assessed in 1944 distal RA anastomoses (Y group: 1811, Aorta group: 133). No significant differences were observed in RA graft patency rate (P = 0.705), overall survival (P = 0.987) and major cardiac event-free survival (P = 0.830) between groups. Multivariable analysis demonstrated that the independent predictors of graft occlusion were age [hazard ratio (HR) 1.025, confidence interval (CI) 1.007-1.044: P = 0.007], female gender (HR 1.391, CI 1.007-1.924: P = 0.047), target of the right coronary artery territory (HR 2.135, CI 1.347-3.382: P = 0.001) and target vessel stenosis ≥90% (HR 0.478, CI 0.291-0.785: P = 0.004). The proximal anastomosis site was not significantly associated with graft occlusion (P = 0.705).
CONCLUSIONS: When target vessel territory and stenosis are appropriately considered, the RA as a secondary conduit can be effectively used for myocardial revascularization, regardless of the proximal anastomosis site.
Keywords
Coronary artery bypassOff-pumpRadial arteryGraft occlusionVascularMyocardial revascularization
MeSH terms
AgedAnastomosis, Surgical*/adverse effectsAnastomosis, Surgical*/methodsAnastomosis, Surgical*/mortalityAnastomosis, Surgical*/statistics & numerical dataCoronary AngiographyCoronary Artery Bypass, Off-Pump*/adverse effectsCoronary Artery Bypass, Off-Pump*/methodsCoronary Artery Bypass, Off-Pump*/mortalityCoronary Artery Bypass, Off-Pump*/statistics & numerical dataDisease-Free SurvivalFemaleGraft Occlusion, VascularHumansMaleMiddle AgedMyocardial RevascularizationPostoperative ComplicationsRadial Artery*/surgeryRadial Artery*/transplantationRetrospective StudiesVascular Patency/physiology*
DOI
10.1093/ejcts/ezy059
PMID
29506024
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Thoracic & Cardiovascular Surgery
AJOU Authors
김, 도정
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