THE USE OF RADIAL ARTERY FOR CORONARY-BYP ASS - A NEW EXPERIENCE 20 YEARS LATER

Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 198 9, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary arter y (LIMA) was concomitantly used as a pedicled graft in 151 cases and t he right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: c ircumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3 %) and three presented a perioperati ve myocardial infarct (2.5 %). Sternal wound infection was noted in th ree cases of double IMA implant. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continue d after discharge. In addition, aspirin (100 mg/day) was given at disc harge. Early angiographic controls (< 3 weeks) were obtained in the fi rst 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/5 8 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localize d narrowing of the RA conduit unrelated to the anastomotic lines (spas m). Late angiographic control (6 to 24 months) was obtained after a me an follow-up of 11 months in 37 patients : 42/46 RA grafts were patent (91.3 %) and free of spasm and 4 were occluded. The use of the RA to complement the pedicled IMA offers excellent short term clinical and a ngiographic results.