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OBJECTIVE: To review the experience of coronary revascularization with the radial artery (RA) for assessment of graft patency and patient outcomes.
METHODS: The RA was harvested using standardized techniques at a single institution on 389 patients from June 2001 to December 2011. Four hundred and fifty RA grafts were performed in 303 males (78%) and 86 females (22%) aged 37 to 75 (mean 59.9) years. Pre-operative Doppler was applied to detect the feasibility of the conduit. An ‘intra-operative Allen’s test’ was introduced to further confirm the collaterals between the RA and the ulnar artery during the harvesting procedure. Four hundred and ninety-five out of 1201 distal anastomoses (41.2%) were constructed using RA. Target coronary arteries receiving RA were the circumflex, the right coronary artery or its branches, and the diagonal. The proximal RA was anastomosed directly to the aorta in 381 cases, with the remaining 8 cases to the left internal mammary artery (LIMA), free right internal mammary artery (FRIMA) or another RA as Y- graft because of the aortic atheroma or calcification. There were 10 off-pump precedures and the remaining 379 cases were under conventional on-pump heart arrest practice.Myocardial pretection was carried out through antegrade and retrograde cold blood cardioplegia delivery. An average of 3.1 grafts per patient was performed (range, 2-6).
RESULTS: There was 1 operative death (1/389, 0.25%), unrelated to the RA graft. No major ischaemic or functional complications occurred in the arm or hand after RA harvesting.Follow-up angiography revealed a 98.3% early patency (<30days, 60/61 patients,1/61with a string sign) and a 92.9% late patency (39/42 patients, 5 ~ 52 months, mean 29 months) with 3 (3/42 patients, 7.1%) occluded RAs. The RA with the string sign was directed to a big right coronary artery with a stenosis around 50%.
CONCLUSIONS: While the pedicled IMA remains the global gold standard for coronary revascularization, the RA is an excellent conduit that broadens the options for total arterial coronary artery bypass surgery.Both careful harvesting techniques and target coronary vessel’s size and degree of stenosis are essential for long-term patency.