Radial artery conduits improve long-term survival after coronary artery bypass grafting

Robert F. Tranbaugh, Kamellia R. Dimitrova, Patricia Friedmann, Charles M. Geller, Loren J. Harris, Paul Stelzer, Bertram Cohen, Darryl M. Hoffman

Research output: Contribution to journalArticle

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Abstract

Background: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). Methods: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. Results: Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001). Conclusions: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.

Original languageEnglish (US)
Pages (from-to)1165-1172
Number of pages8
JournalAnnals of Thoracic Surgery
Volume90
Issue number4
DOIs
StatePublished - 2010
Externally publishedYes

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Radial Artery
Saphenous Vein
Coronary Artery Bypass
Mammary Arteries
Survival
Transplants
Mortality
Social Security
Hospital Mortality
Proportional Hazards Models
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Tranbaugh, R. F., Dimitrova, K. R., Friedmann, P., Geller, C. M., Harris, L. J., Stelzer, P., ... Hoffman, D. M. (2010). Radial artery conduits improve long-term survival after coronary artery bypass grafting. Annals of Thoracic Surgery, 90(4), 1165-1172. https://doi.org/10.1016/j.athoracsur.2010.05.038

Radial artery conduits improve long-term survival after coronary artery bypass grafting. / Tranbaugh, Robert F.; Dimitrova, Kamellia R.; Friedmann, Patricia; Geller, Charles M.; Harris, Loren J.; Stelzer, Paul; Cohen, Bertram; Hoffman, Darryl M.

In: Annals of Thoracic Surgery, Vol. 90, No. 4, 2010, p. 1165-1172.

Research output: Contribution to journalArticle

Tranbaugh, RF, Dimitrova, KR, Friedmann, P, Geller, CM, Harris, LJ, Stelzer, P, Cohen, B & Hoffman, DM 2010, 'Radial artery conduits improve long-term survival after coronary artery bypass grafting', Annals of Thoracic Surgery, vol. 90, no. 4, pp. 1165-1172. https://doi.org/10.1016/j.athoracsur.2010.05.038
Tranbaugh, Robert F. ; Dimitrova, Kamellia R. ; Friedmann, Patricia ; Geller, Charles M. ; Harris, Loren J. ; Stelzer, Paul ; Cohen, Bertram ; Hoffman, Darryl M. / Radial artery conduits improve long-term survival after coronary artery bypass grafting. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 4. pp. 1165-1172.
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abstract = "Background: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). Methods: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. Results: Perioperative outcomes including in hospital mortality (0.1{\%} for the RA patients and 0.2{\%} for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3{\%}, 93.9{\%}, and 83.1{\%} for the RA group versus 97.2{\%}, 88.7{\%}, and 74.3{\%} for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52{\%} increased mortality for the SV patients (25.7{\%}) versus the RA patients (16.9{\%}; p = 0.0011). For symptomatic patients, RA patency was 80.7{\%}, which was not different than the LITA patency rate of 86.4{\%} but was superior to the SV patency rate of 46.7{\%} (p < 0.001). Conclusions: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.",
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T1 - Radial artery conduits improve long-term survival after coronary artery bypass grafting

AU - Tranbaugh, Robert F.

AU - Dimitrova, Kamellia R.

AU - Friedmann, Patricia

AU - Geller, Charles M.

AU - Harris, Loren J.

AU - Stelzer, Paul

AU - Cohen, Bertram

AU - Hoffman, Darryl M.

PY - 2010

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N2 - Background: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). Methods: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. Results: Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001). Conclusions: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.

AB - Background: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). Methods: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. Results: Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001). Conclusions: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG.

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