Radial artery supply to the left mammary artery in a redo coronary bypass (original) (raw)
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Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular, 2007
OBJECTIVE We sought to compare early clinical outcomes in patients receiving a right internal thoracic artery or a radial artery as the second arterial graft in myocardial revascularization. METHODS We retrospectively studied 58 consecutive patients who underwent coronary artery bypass surgery and received both a left internal thoracic artery graft and either a right internal thoracic artery (n=20) or a radial artery graft (n=38), between January 2004 and March 2006. Hospital mortality, pleural drainage, operative time and postoperative complications were analyzed. RESULTS There were no significant preoperative differences between groups. There was only one (1.7%) in-hospital death which occurred in the Radial Group. Operative times was significantly higher in the Right Internal Thoracic Group (p-value = 0.0018), but were not associated with increased Intensive Care Unit stays, mechanical ventilation or other postoperative complications. We were able to perform significantly more di...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
Multiple arterial coronary artery grafting (MABG) improves long-term survival compared with single arterial CABG (SABG), yet the best second arterial conduit to be used with the left internal thoracic artery (LITA) remains undefined. Outcomes in patients grafted with radial artery (RA-MABG) versus right internal thoracic artery (RITA-MABG) as the second arterial graft were compared with SABG. Multi-institutional, retrospective analysis of non-emergent isolated LITA to left anterior descending coronary artery CABG patients was performed using institutional Society of Thoracic Surgeon National Adult Cardiac Surgery Databases. 4484 (54.5%) SABG [LITA ± saphenous vein grafts (SVG)], 3095 (37.6%) RA-MABG (RA ± SVG) and 641 (7.9%) RITA-MABG (RITA ± SVG) patients were included. The RITA was used as a free (68%) or in situ (32%) graft. RA grafts were principally anastomosed to the ascending aorta. Long-term survival was ascertained from US Social Security Death Index and institutional follo...
Radial Artery as a Graft for Coronary Artery Bypass Grafting
Circulation Journal, 2009
he superiority of the left internal thoracic artery (LITA) over the saphenous vein (SV) in coronary artery bypass grafting (CABG) was widely accepted in angiographic studies in the 1980 s. 1,2 The clinical importance of the LITA to the left anterior descending artery (LAD) graft was emphasized in a long-term follow-up study comparing it with the SV over 20 years. 3 The graft patency rate of the LITA to the LAD graft was approximately 90%, and that of SV grafts was 50-60% at 10 years after CABG. 4,5 Because the SV developed intimal hyperplasia and graft atherosclerosis, which caused late graft occlusion, various arterial grafts have been adopted over the past 30 years. The right internal thoracic artery (RITA), 6,7 the right gastroepiploic artery (GEA), 8,9 the radial artery (RA), 10,11 and the inferior epigastric artery (IEA) 12,13 have been used in addition to the LITA. According to the database of Japanese Association for Coronary Artery Surgery in 2004, the LITA comprised 37.5% of the total grafts. Other arterial grafts were 14.5% (RITA), 14.7% (RA), and 9.1% (GEA). Arterial grafts accounted for 76% of total grafts in Japan, which is significantly higher than in Western countries. Here I review the current status of the RA graft as the second choice of arterial graft after the LITA.
2010
Objective: We sought to evaluate whether the radial artery (RA) provides the same clinical and angiographic results when proximally anastomosed to the aorta or to the left internal thoracic artery (ITA) as a composite Y-graft. Methods: From February 1999 to December 2002, 512 patients underwent myocardial revascularization using the RA, the left ITA and, when required, the saphenous vein. According to the surgeons' preference the RA was proximally anastomosed to the aorta (336 patients (65.6%), Ao-Cor group) or to the left ITA as a composite Y-graft (176 patients (34.4%), Y-graft group). There was a significant prevalence of three-vessel disease (86.8 versus 73.2%, P ¼ 0:000) and elderly age (60 ^ 9 versus 58 ^ 8 years, P ¼ 0:014) in the Y-graft group. Results: Patients in Y-graft group had longer aortic cross clamp time ðP ¼ 0:001Þ; more bypass grafts per patient ðP # 0:001Þ; more arterial bypass grafts per patient ðP # 0:001Þ and more bypass grafts per patient with the RA ðP ...
Journal of Cardiac Surgery, 2005
The aim of this study is to evaluate the mid-results of the use of the radial artery alongside the internal mammary artery for complete arterial revascularization in elective and nonelective coronary bypass graft surgery. Methods: All patients undergoing coronary artery surgery alone over a 3-year period with disease of more than one coronary artery were considered for complete arterial revascularization. Preoperatively, all patients had an Allen's test on the dominant arm and a cutoff point of 10 seconds was used. These patients were initially followed in the outpatient clinic after 6 weeks and then further followed up with the help of a mailed questionnaire. The incidence of recurrent angina and reangiogram was obtained and selected patients were further interviewed and examined in the outpatient department. Results: Over a 3-year period, 291 patients underwent total arterial revasularization using the radial and internal mammary arteries alone in Y-graft configuration. The mean age of the study population was 62.4 ± 8.8 years, with a male to female ratio of 221 to 70. Elective surgery was performed in 230 patients (79.4%), with nonelective procedures comprising a total of 61 patients (20.6%). The mean number of distal anastomoses was 2.9 ± 0.9. There were four perioperative mortalities (1.37%) and 43 patients (14.7%) developed low cardiac output syndrome, requiring inotropes with or without intra-aortic balloon pump. Forty patients (13.7%) developed postoperative supraventricular arrhythmias. There was no incidence of hand ischemia or wound complications. After a mean follow-up period of 35.4 ± 6.3 months of 220 patients (75%), there was one further death and 24 patients required readmissions for cardiac-related causes. Ten patients had reangiogram for angina of which one patient had a blocked radial artery graft and two patients underwent angioplasty to their native coronary arteries. The patients' angina score was currently 0.5 ± 1.0 versus 2.6 ± 1.4 preoperatively. Conclusion: Total arterial revascularization with the internal mammary and radial artery is associated with a low rate of perioperative complications and mortality and can be safely used in both elective and nonelective bypass graft surgery with excellent clinical results.