This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 109/12/1489    most recent 01.CIR.0000121743.10146.78v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zacharias, A. Articles by Shah, A. Search for Related Content PubMed PubMed Citation Articles by Zacharias, A. Articles by Shah, A. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections Restenosis CV surgery: coronary artery disease Coronary circulation

(Circulation. 2004;109:1489-1496.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Improved Survival With Radial Artery Versus Vein Conduits in Coronary Bypass Surgery With Left Internal Thoracic Artery to Left Anterior Descending Artery Grafting

Anoar Zacharias, MD; Robert H. Habib, PhD; Thomas A. Schwann, MD; Christopher J. Riordan, MD; Samuel J. Durham, MD; Aamir Shah, MD

From the Division of Cardiovascular Surgery, St Vincent Mercy Medical Center, Toledo (A.Z., R.H.H., T.A.S., C.J.R., S.J.D., A.S.); Division of Cardiovascular Surgery, St Luke’s Hospital, Maumee (A.Z., R.H.H., T.A.S., C.J.R., S.J.D., A.S.); and Departments of Surgery (A.Z., T.A.S., C.J.R., S.J.D., A.S.) and Medicine (R.H.H.), Medical College of Ohio, Toledo, Ohio.

Correspondence to Dr Robert H. Habib, Director, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry St, ACC Bldg, Suite 309, Toledo, OH 43608. E-mail Robert_Habib{at}mhsnr.org

Received October 21, 2003; revision received January 9, 2004; accepted January 9, 2004.

Background— Given its proven survival benefit, left internal thoracic artery to left anterior descending (LITA-LAD) grafting has become a fundamental part of CABG. This grafting also led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting improves survival beyond that achieved by LITA-LAD alone is not known.

Methods and Results— We compared 6-year outcomes in propensity-matched CABG-LITA-LAD patients (925 each) divided into those with 1 radial grafts and those with vein-only grafting. Matched patients had essentially identical demographics, comorbidities, coronary disease, and operative data. Perioperative outcomes, including death (radial, 11 [1.2%]; vein, 10 [1.1%]), were similar for the 2 groups. Cumulative 0- to 6-year survival was better for radial patients (risk ratio, 0.675), particularly after 3 years (P<0.03). Six-year survival in vein (86.8%) and radial (92.1%) patients indicated 67% greater overall vein mortality. Incidence rates of radial and vein repeated catheterization (190 of 925 [20.5%] versus 199 of 925 [21.5%]) and revascularization (8.8% versus 8.5%) were similar. Angiography data in restudied symptomatic patients showed a trend for greater radial patency. Vein failure (66 of 161 [41%]) was significantly worse than radial failure (46 of 157 [29.3%]) in patients receiving both types of grafts (P=0.039).

Conclusions— Using radial as a second arterial conduit in CABG-LITA-LAD as opposed to vein grafting improves long-term outcomes as a result of decreased late deaths, especially after the third postoperative year.

Key Words: angiography • revascularization • coronary disease • restenosis

This article has been cited by other articles:

				T. A. Schwann, A. Zacharias, C. J. Riordan, S. J. Durham, A. S. Shah, and R. H. Habib Does radial use as a second arterial conduit for coronary artery bypass grafting improve long-term outcomes in diabetics? Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 914 - 923. [Abstract] [Full Text] [PDF]

				S. Damgaard, J. T. Lund, N. B. Lilleor, M. J. Perko, K. Sander, B. Dimo, M. B. Jensen, J. K. Madsen, H. Kelbaek, and D. A. Steinbruchel Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1069 - 1075. [Abstract] [Full Text] [PDF]

				S. Bleiziffer, I. Hettich, B. Eisenhauer, D. Ruzicka, M. Wottke, J. Hausleiter, S. Martinoff, M. Morgenstern, and R. Lange Patency rates of endoscopically harvested radial arteries one year after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 649 - 656. [Abstract] [Full Text] [PDF]

				T. A. Schwann, A. Zacharias, C. J. Riordan, S. J. Durham, A. S. Shah, and R. H. Habib Survival and Graft Patency After Coronary Artery Bypass Grafting With Coronary Endarterectomy: Role of Arterial Versus Vein Conduits Ann. Thorac. Surg., July 1, 2007; 84(1): 25 - 31. [Abstract] [Full Text] [PDF]

				R. H. Habib, A. Zacharias, and T. A. Schwann Long-term Mortality Associated With Aprotinin Following Coronary Artery Bypass Graft Surgery JAMA, June 13, 2007; 297(22): 2476 - 2477. [Full Text] [PDF]

				J. W. Fischer Tenascin-C: A key molecule in graft stenosis Cardiovasc Res, June 1, 2007; 74(3): 335 - 336. [Full Text] [PDF]

				S. Na, Y. J. Oh, Y. H. Shim, Y. W. Hong, S. O. Bang, and Y. L. Kwak Effects of milrinone on blood flow of the Y-graft composed with the radial and the internal thoracic artery in patients with coronary artery disease. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 324 - 328. [Abstract] [Full Text] [PDF]

				S. M. Wildhirt, B. Voss, F. von Canal, M. Benz, J. B. Grammer, R. Bauernschmitt, P. Tassani, and R. Lange Graft function, histopathology and morphometry of radial arteries used as conduits for myocardial revascularization in patients beyond age 70. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 333 - 340. [Abstract] [Full Text] [PDF]

				D. G. Nezic, A. M. Knezevic, P. S. Milojevic, B. P. Dukanovic, M. D. Jovic, M. D. Borzanovic, and A. N. Neskovic The fate of the radial artery conduit in coronary artery bypass grafting surgery. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 341 - 346. [Abstract] [Full Text] [PDF]

				D. Di Lazzaro, T. Ragni, G. Di Manici, G. Bardelli, U. Da Col, F. Grasselli, A. Antoniella, W. Papa, F. Crusco, and A. Giovagnoni Noninvasive midterm follow-up of radial artery bypass grafts with 16-slice computed tomography. Ann. Thorac. Surg., July 1, 2006; 82(1): 44 - 50. [Abstract] [Full Text] [PDF]

				D. G. Nezic, A. M. Knezevic, M. Dj. Jovic, and S. D. Borovic Angiographic Patency of the Radial Artery Conduit in Coronary Artery Bypass Grafting Ann. Thorac. Surg., April 1, 2006; 81(4): 1551 - 1551. [Full Text] [PDF]

				L. R. Sajja and G. Mannam Reply Ann. Thorac. Surg., April 1, 2006; 81(4): 1551 - 1552. [Full Text] [PDF]

				Vascular-wall remodeling of 3 human bypass vessels: organ culture and smooth muscle cell properties. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 651 - 658.

				I. Parvaiz, J. T. Lund, and H. Kelbaek The Arterial Sling Operation: One-Year Follow-Up Ann. Thorac. Surg., October 1, 2005; 80(4): 1375 - 1380. [Abstract] [Full Text] [PDF]

				K. Knobloch, A. Lichtenberg, S. Tomaszek, C. Hagl, N. Khaladj, U. Klima, and A. Haverich Long-Term Physical Activity and Neurologic Function After Harvesting of the Radial Artery as T-Graft or Free Graft in Coronary Revascularization Ann. Thorac. Surg., September 1, 2005; 80(3): 918 - 921. [Abstract] [Full Text] [PDF]

				A. Zacharias, R. H. Habib, T. A. Schwann, and C. J. Riordan Arterial versus vein graft patency in coronary artery bypass grafting patients with ischemia-directed repeat angiography Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 510 - 511. [Full Text] [PDF]

				D. Glineur, P. Noirhomme, J. Reisch, G. El Khoury, P. Astarci, and C. Hanet Resistance to Flow of Arterial Y-Grafts 6 Months After Coronary Artery Bypass Surgery Circulation, August 30, 2005; 112(9_suppl): I-281 - I-285. [Abstract] [Full Text] [PDF]

				J. Kobayashi, T. Tashiro, M. Ochi, H. Yaku, G. Watanabe, T. Satoh, O. Tagusari, H. Nakajima, S. Kitamura, and for the Japanese Off-Pump Coronary Revascularizati Early Outcome of a Randomized Comparison of Off-Pump and On-Pump Multiple Arterial Coronary Revascularization Circulation, August 30, 2005; 112(9_suppl): I-338 - I-343. [Abstract] [Full Text] [PDF]

				G. P. Georghiou, B. A. Vidne, and J. Dunning Does the radial artery provide better long-term patency than the saphenous vein? Interactive CardioVascular and Thoracic Surgery, August 1, 2005; 4(4): 304 - 310. [Abstract] [Full Text] [PDF]

				K. Matsuura, J. Kobayashi, O. Tagusari, K. Bando, K. Niwaya, H. Nakajima, T. Yagihara, and S. Kitamura Off-Pump Coronary Artery Bypass Grafting Using Only Arterial Grafts in Elderly Patients Ann. Thorac. Surg., July 1, 2005; 80(1): 144 - 148. [Abstract] [Full Text] [PDF]

				A. Zacharias, R. H. Habib, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Radial artery conduits in coronary artery bypass grafting: Current perspective J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 232 - 233. [Full Text] [PDF]

				S. Mussa, B. P. Choudhary, and D. P. Taggart Reply to the Editor: J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 233 - 233. [Full Text] [PDF]

				R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 1976 - 1986. [Abstract] [Full Text] [PDF]

				U. N. Khot, D. T. Friedman, S. G. Ellis, A. Montoli, N. D. Desai, and S. E. Fremes Radial-Artery Coronary Bypass Grafts N. Engl. J. Med., March 3, 2005; 352(9): 941 - 942. [Full Text] [PDF]

				C. Acar, R. C. Cook, S. G. Raja, S. Hashim, I. Birdi, P. J. Shah, R. A. Baker, J. J. Knight, U. N. Khot, D. T. Friedman, et al. Letters Regarding Article by Khot et al, "Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts" * Letters Regarding Article by Khot et al, "Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts" * Letters Regarding Article by Khot et al, "Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts" * Letters Regarding Article by Khot et al, "Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts" * Response Circulation, January 4, 2005; 111(1): e6 - e9. [Full Text] [PDF]

				S. M. Wildhirt INVITED COMMENTARY Ann. Thorac. Surg., November 1, 2004; 78(5): 1621 - 1622. [Full Text] [PDF]

				S. G. Raja, A. Zacharias, R. H. Habib, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Radial Artery as the Second Choice Conduit: Some Unsolved Problems * Response Circulation, August 10, 2004; 110(6): e62 - e63. [Full Text] [PDF]

				C. Chen-Scarabelli, T. Scarabelli, A. Zacharias, R. H. Habib, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Factors Affecting Graft Patency: The Operating Room and Beyond * Response Circulation, August 10, 2004; 110(6): e64 - e64. [Full Text] [PDF]

				S. Verma, P. E. Szmitko, R. D. Weisel, D. Bonneau, D. Latter, L. Errett, Y. LeClerc, and S. E. Fremes Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting? Circulation, August 3, 2004; 110(5): e40 - e46. [Full Text] [PDF]