Midterm Graft Patency in Symptomatic Patients After

Objectives: The use of multiple arterial grafts (MAGs) in the surgical therapy of coronary heart disease is technically more difficult. For good long-term results and patency rate, the guidelines prefer the use of arterial grafts, but the importance of right internal thoracic artery (RIMA), radial artery (RA), and saphenous vein (SV) is still under discussion.

Methods: In a retrospective analysis, the midterm results after predominantly or completely arterial coronary bypass grafting in 708 patients were evaluated. Coronary angiography was performed in 80 symptomatic patients during the follow-up examination within 22.4 ±16.8 months.

Result: The study cohort was subdivided into the use of bilateral ITA (BITA): 16.4%, left ITA (LITA) +RA: 63.8% and BITA + RA: 19.8%. The follow-up rate was 71% (507 patients) within 50.0 ± 14.5 months. Mean number of anastomosis was 2.8 ± 0.7 vs. 3.1 ± 0.8 vs. 3.4 ± 0.6 and portion of venous grafts was 46.6 vs. 57.3% vs. 11.4% (BITA vs. LITA + RA vs. BITA + RA, p < 0.000). A total of 80 (16.9%) patients (12.9 vs. 16.2 vs. 15.7% BITA vs. LITA + RA vs. BITA + RA, p = 0.004) received a coronary angiogram within a follow-up period of 22.4 ± 16.8 months. Two examinations were available for 14 patients so that 282 anastomoses (LITA: 119, RITA: 27, RA: 87, SV: 49) could be assessed. Patency rate was 84%: LITA, 75%: RITA, 71.3%: RA, and 81.6%: SV. The use of T-Graft had no significantly influence for the patency of LITA (80 vs. 86.4% T-graft vs. no T-graft, p = ns). Central anastomosis technique of the RITA (76.2 vs. 71.4% RITA in-situ vs. RITA T-graft, p = ns) as well as RA (82.1 vs. 65.4% aortal vs. T-graft p = ns) demonstrated no significantly difference in patency. Similar patency rate was obtained for single versus sequential anastomosis of the LITA (80.7 vs. 83.3%, p = ns). The RITA showed the best patency rate in cases of anastomosis to anterolateral territory (88.9%) versus (64.3%) to the right coronary territory (p = ns). Hospital mortality (1.7 vs. 2 vs. 0%) and midterm mortality (4.3 vs. 7.7 vs. 4.7%, BITA vs. LITA + RA vs. BITA + RA, p = ns) were comparable between the subgroups.

Conclusion: In this particular study examining symptomatic patients, the use of the RITA or RA showed no advantage. The patency of SV grafts was no worse than that of RITA or RA. The small number of patients limits the validity of the study. Finally, a comparison of asymptomatic patients needs to be performed to identify an advantage in patency rate of arterial and venous grafts.

Publication History

Article published online:
19 February 2021