Conduit Choice for Composite Arterial Grafting In Off Pump Coronary Revascularization - Internal Thoracic Artery or Radial Artery
Akitoshi Takazawa, Hiroyuki Nakajima, Chiho Tokunaga, Akihiro Yoshitake, Toshihisa Asakura, Atsushi Iguchi
Saitama Medical University International Medical Center, Hidaka city, Japan
BACKGROUND:
Composite grafting is useful to achieve more “arterial” revascularization without aortic manipulations. In present study, we retrospectively examined graft flow and patency to delineate efficacy of composite grafting with the free internal thoracic artery (ITA) or radial artery (RA) in off pump coronary artery bypass graft(OPCAB).
METHODS: We reviewed clinical records of 90 patients(148 anastomoses) who underwent OPCAB with a composite graft between May 2007 and January 2019. Of these, 26 patients (group R;61 anastomoses) had a composite graft with RA to diagonal in 2 anastomoses(3.3%), circumflex in 41(67.2%), and right coronary artery (RCA) in 18(29.5%), while 64 patients (group I;87 anastomoses) had a composite graft with free ITA to diagonal in 21 anastomoses(24.1%), circumflex in 59(67.8%), and RCA in 7(8.1%). Graft flow was measured at the proximal portion of the in-situ ITA by transit-time flowmetry (TTFM), intraoperatively. Postoperative catheter or computed tomography angiography was performed in 51 patients for clinical reasons.
RESULTS: At the baseline, there was no significant difference between the two groups. The number of distal anastomoses in Group R was significantly greater than that in Group I (4.5 vs 3.5, p<0.001), and the rate of targets with moderate stenosis in Group R was significantly higher than that in group I (19% vs. 9%, p<0.01)In the results, the mean graft flow (MGF; ml/min) in the group R was significantly larger than that in the group I (79.5 vs 64.5, p=0.03). The rates of low graft flow (MGF < 20) in the group R were comparable (15% vs.1.5%, p=0.94). In the postoperative angiography, the rates of completely patent composite graft were 96.2% in the group R and 100% in group I.CONCLUSIONS: Composite grafting is less invasive and useful to achieve more arterial revascularization with minimal graft materials. Low graft flow can be avoided by appropriate target selection. To our experience, MGF was increased along with flow demand. RA may be the first choice for the target distant or two or more targets. A short segment of free ITA is useful, when the targets are close each other.