Early outcomes of radial artery use in all-arterial grafting of the coronary arteries in patients 65 years and older

• Published in: Texas Heart Institute journal 2010, Vol.37 (3), p.301-306
• Main Authors: Erdil, Nevzat, Nisanoglu, Vedat, Eroglu, Tamer, Fansa, Iyad, Cihan, Hasan Berat, Battaloglu, Bektas
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Chi-Square Distribution; Clinical Investigation; Coronary Angiography; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Female; Humans; Length of Stay; Linear Models; Male; Radial Artery - diagnostic imaging; Radial Artery - transplantation; Retrospective Studies; Risk Assessment; Risk Factors; Saphenous Vein - diagnostic imaging; Saphenous Vein - transplantation; Surgical Wound Infection - etiology; Time Factors; Tissue and Organ Harvesting - adverse effects; Treatment Outcome; Turkey; Vascular Patency
• ISSN: 0730-2347; 1526-6702

We retrospectively evaluated early clinical results of coronary revascularization using none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive patients who had undergone isolated myocardial revascularization were divided into 2 groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA) graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA. There was no significant difference between the groups' rates of mortality. The arterial conduit group had a significantly shorter overall postoperative hospital stay than did the mixed-conduit group (mean, 6.6 +/- 0.9 vs 7.2 +/- 5 days; P=0.04). Linear regression analysis revealed that the presence of hypertension (beta=0.13; 95% confidence interval [CI], 0.054-0.759; P=0.02) and high EuroSCORE (beta=0.24; 95% CI, 0.053-0.283; P=0.004) were the major predicting factors for long hospital stay. Graft-harvest-site infection was statistically more frequent in the mixed-conduit group than in the arterial conduit group (6.4% vs 0, respectively; P=0.007). Angiography was performed postoperatively (mean, 24.9 +/- 16.3 mo; range, 11-65 mo) in 21 patients. In these patients, all LIMA grafts were patent, as were 86.9% of the SVGs and 90.9% of the RA grafts. Myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged 65 years and older is safe and reliable, produces short-term results equal to those of saphenous vein grafting, and can reduce graft-harvest-site infections.