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OBJECTIVE: Over the past two decades the radial artery has regained its popularity in complementing the left internal mammary in CABG. Furthermore, it has been proven that the main stem of the LIMA allows sufficient flow reserve to achieve full-arterial revascularization with a Y-graft construction for three vessel disease. The main advantage of this technique is to avoid aortic manipulation during off-pump CABG surgery, thereby minimizing the chance of cerebrovascular accidents and myocardial damage due to cardioplegic arrest. The aim of this study was to analyze the clinical long-term follow-up of patients who underwent off-pump CABG surgery using total arterial grafting and no-touch technique at our institution.
METHODS: The study cohort consisted of 293 consecutive patients enrolled as all-comers undergoing no-touch aorta off-pump CABG surgery with a radial artery as Y-graft to the LIMA. End points were defined as in-hospital and at maximum follow-up major adverse cardiovascular or cerebrovascular events, defined as all-cause death, stroke, myocardial infarction, and any repeat revascularization. Data was collected from patient charts of the last visit to the cardiologist and mortality was checked at the National Civil Registry.
RESULTS: The median length of follow-up was 5.2 years, range 1.0 to 8.8 years. The number of distal anastomosis per patient was 3.6±0.8 with a median of 4. In hospital mortality was 1.0%, stroke 0,0%, percutaneous coronary intervention 0.0%, and reoperation for graft occlusion 0.7%. At maximum follow-up overall mortality was 9.6%, stroke 4.8%, percutaneous coronary intervention 9.6%, and redo-CABG 0.0%. 18.1% of the patients had recurrent angina pectoris complaints and 4.4% had a myocardial infarction.

CONCLUSIONS: Total arterial off-pump CABG surgery can be safely performed with low in hospital mortality, overall mortality, need for repeat revascularization and stroke rate. The no-touch aorta technique with the radial artery as Y-graft to the internal mammary artery provides excellent long-term results and we suggest it as treatment of choice for patients with three-vessel disease.