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J Chest Surg

Published online February 15, 2021

Copyright © Journal of Chest Surgery.

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

Seung Keun Yoon , M.D., Hyun Song , M.D., Ph.D., Ju Yong Lim , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Ju Yong Lim
Tel 82-2-2258-6769
Fax 82-2-594-8644
E-mail millalim92@gmail.com
ORCID
https://orcid.org/0000-0003-4961-4890

Received: June 24, 2020; Revised: November 17, 2020; Accepted: November 20, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Coronary artery bypass grafting, Radial artery, Vascular patency, Vascular graft occlusion, Surgical anastomosis

Article

ahead

J Chest Surg

Published online February 15, 2021

Copyright © Journal of Chest Surgery.

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

Seung Keun Yoon , M.D., Hyun Song , M.D., Ph.D., Ju Yong Lim , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Ju Yong Lim
Tel 82-2-2258-6769
Fax 82-2-594-8644
E-mail millalim92@gmail.com
ORCID
https://orcid.org/0000-0003-4961-4890

Received: June 24, 2020; Revised: November 17, 2020; Accepted: November 20, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Coronary artery bypass grafting, Radial artery, Vascular patency, Vascular graft occlusion, Surgical anastomosis

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