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

 Do Jung Kim  ;  Seung Hyun Lee  ;  Hyun-Chel Joo  ;  Kyung-Jong Yoo  ;  Young-Nam Youn 
 European Journal of Cardio-Thoracic Surgery, Vol.54(3) : 475-482, 2018 
Journal Title
 European Journal of Cardio-Thoracic Surgery 
Issue Date
Coronary artery bypass ; Off-pump ; Radial artery ; Graft occlusion ; Vascular ; Myocardial revascularization
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.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Jung(김도정)
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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