Long-term follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts: survival, cardiac morbidity and quality of life

Fleißner, Felix; Engelke, Hendrick; Rojas, Sebastián V.; Ismail, Ismail A.; Stiefel, Penelope; Cebotari, Serghei; Haverich, Axel; Shrestha, Malakh; Martens, Andreas

doi:10.1093/ejcts/ezv289

Cited by 15 publications

(10 citation statements)

References 23 publications

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“…The main finding of our study is that multiple arterial grafting using a LITA and RA as a composite T-graft was Our results are consistent with other studies that have alluded to improved survival when using the RA in multiple arterial grafting. [17][18][19] Buxton and colleagues validated the association of TAR using the LITA and RA with improved long-term survival benefit compared to ACVB in a propensitymatched cohort study after 15 years of follow-up (54% ± 3.3% vs. 41% ± 3.0%, P = 0.0004). 20) Another large cohort study conducted by Schwann et al investigated propensity-matched patients undergoing non-salvage primary CABG at two institutions.…”

Section: Discussionmentioning

confidence: 98%

Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

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Fleißner

Martens

et al. 2020

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Aims: Compelling evidence encourages the use of the radial artery (RA) as the second arterial graft in coronary artery bypass grafting (CABG). However, its long-term benefits remain disputed. We sought to evaluate long-term outcome and survival by comparing patients receiving RAs with those receiving venous grafts to a single internal thoracic artery (ITA). Methods: We analyzed 345 patients undergoing primary multivessel CABG and conducted a 13-year long follow-up. In all, 187 patients received the RA and the left ITA as T-graft; 158 patients received saphenous veins complementing a single ITA. We performed propensity-score matching on 81 pairs to balance treatment selection and confounders. Results: Patients receiving RAs were younger and less likely to be female or to have pulmonary hypertension, impaired renal function, or left main coronary disease. At 30 days, they showed significantly lower unadjusted mortality and renal impairment. Unadjusted long-term survival was superior in the RA group, even after propensity-score matching. We found that RA use protected from late mortality. Conclusions: Using the RA and the left ITA as T-graft is associated with a significant longterm survival benefit in patients undergoing CABG. It may display a promising alternative to conventional use of a single ITA supplemented by saphenous veins.

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Section: Discussionmentioning

confidence: 98%

Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Obed

Fleißner

Martens

et al. 2020

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“…lent long-term patency rates when targeted to severely stenosed coronary vessels [12][13][14] ( Figure 1). Throughout recent years, the outcomes of RA grafting has been extensively compared with long saphenous vein grafting; in all studies with a mean follow-up time extending beyond a year postoperation, significant benefits in terms of graft patency have been demonstrated for RA grafts.…”

Section: Does Previous Transradial Catheterization Preclude Use Of Thmentioning

confidence: 99%

Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

et al. 2016

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AbstrAct:The radial artery (RA) is a commonly used conduit for coronary artery bypass grafting, and recent studies have demonstrated that it provides superior long-term patency rates to the saphenous vein in most situations. In addition, the RA is also being used with increasing frequency as the access point for coronary angiography and percutaneous coronary interventions. However, there has been concern for many years that these transradial procedures may have a detrimental impact on the function of RA grafts used in coronary artery bypass grafting, and there is now comprehensive evidence that such interventions cause morphologic and functional damage to the artery in situ. Despite this, there remain remarkably few studies investigating the use of previously cannulated RAs as grafts in coronary artery bypass surgery, and there are no clear guidelines on the use of the RA in coronary artery bypass grafting after its catheterization. This article will review concisely the evidence that transradial procedures cause damage to the RA, and discuss the impact this could have on previously cannulated RAs used as coronary artery bypass grafting conduits. On the basis of the evidence assessed, we make a number of recommendations to both surgeons and cardiologists regarding use of the RA in cardiovascular procedures.

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“…Greater use of multiple arterial grafts during CABG has repeatedly been shown to improve event-free survival of patients undergoing multivessel coronary artery bypass grafting [ 14 – 19 ] including the use of the radial artery as a second arterial graft [ 20 , 21 ]. Despite this data and support from guideline recommendations, the use of multiple arterial grafts during surgical revascularization has not translated into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Management and Prevention of Saphenous Vein Graft Failure: A Review

et al. 2017

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Coronary artery bypass grafting (CABG) remains a vital treatment for patients with multivessel coronary artery disease (CAD), especially diabetics. The long-term benefit of the internal thoracic artery graft is well established and remains the gold standard for revascularization of severe CAD. It is not always possible to achieve complete revascularization through arterial grafts, necessitating the use of saphenous vein grafts (SVG). Unfortunately, SVGs do not have the same longevity, and their failure is associated with significant adverse cardiac outcomes and mortality. This paper reviews the pathogenesis of SVG failure, highlighting the difference between early, intermediate, and late failure. It also addresses the different surgical techniques that affect the incidence of SVG failure, as well as the medical and percutaneous prevention and treatment options in contemporary practice.

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Long-term follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts: survival, cardiac morbidity and quality of life

Abstract: Total arterial revascularization using composite LITA-RA T-grafts leads to excellent long-term results after >10 years.

Cited by 15 publications

References 23 publications

Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

Management and Prevention of Saphenous Vein Graft Failure: A Review

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