Radial artery coronary bypass grafting: Surgical outcomes of an unexplored innovation in a developing country

Abstract

Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial arterycoronary artery bypass graft patients in a tertiary-care setting.Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, fromSeptember 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary arterybypass grafting for coronary artery disease involving two or more vessels. The subjects approached for the use oftheir radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay >9 days.Multivariable logistic regression was used to identify independent predictors of the length of hospital stay. Data wasanalysed using SPSS 21.Results: Of the 97 patients, 84(86.6%) were males. The overall mean age of the sample was 58.33±8.34 years. Meanlength of hospital stay was 8.10±2.37 days, and 23(23.7%) patients had prolonged stay. Higher age was a significantpredictor of prolonged hospital stay (p<0.05). Besides, 23(23.7%) patients developed acute kidney injury. There wasno incidence of wound, infection or deep venous thrombosis, while 1(1.03%) patient had to be reopened due toexcessive postoperative bleeding, and it represented the lone mortality.Conclusion: Patient age was found to be a significant predictor of prolonged hospital stay in patients undergoingradial artery coronary artery bypass graft, while almost a quarter of the sample was affected by acute kidney injury.Keywords: Coronary artery bypass graft, Radial artery, Prolonged length of stay, Acute kidney injury, Ejectionfraction.
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Early Post-operative Outcomes of Single versus Multiple Arterial Grafts in Coronary Artery Bypass Grafting; A Comparative Analysis

“…Our findings were similar with the previous studies which demonstrated mean length of hospital stay as 8.10±2.37 days in conventional CABG group and higher age as significant predictor of prolonged hospital stay (p<0.05). 6,[16][17][18][19] A study by Parasca,C. A et al, found mean aortic cross-clamp time and CPB time to be higher in arterial group when compared with venous group (62.3±24.6mins, 92.7±31.7mins vs 55.9±35.7, 87.8±35.9) respectively due to technically demanding anastomosis with arterial grafts.…”

“…5 Because arterial grafts are less likely to develop atherosclerosis and occlusion than venous grafts, arterial grafts may offer greater long-term patency. 3,6 Other arterial grafts that have been used in CABG surgery over time include the Right Internal Mammary Artery (RIMA), the Radial Artery (RA) and the gastroepiploic artery. 6 RA as a bypass conduit in CABG surgery was used by Carpentier and associates in 1973 who reported the short-term outcomes of 40 grafts in 30 patients.…”

“…3,6 Other arterial grafts that have been used in CABG surgery over time include the Right Internal Mammary Artery (RIMA), the Radial Artery (RA) and the gastroepiploic artery. 6 RA as a bypass conduit in CABG surgery was used by Carpentier and associates in 1973 who reported the short-term outcomes of 40 grafts in 30 patients. However within a couple of years of their initial publication, they contradicted their own results due to the high incidence of graft occlusion and narrowing when compared to saphenous vein grafts on control angiography.…”