CORONARY REVASCULARIZATION WITH THE RADIAL ARTERY - NEW INTEREST FOR AN OLD CONDUIT

Between July 1992 and May 1994, 148 patients (18 females) underwent my ocardial revascuuarization with a radial artery (RA) graft. The left R A was used in 97.3% of cases. All but two patients received at least o ne additional arterial conduit: 137 left and 59 right intrnal mammary arteries (IMA); 23 inferior epigastric arteries; and 21 right gastroep iploic arteries. Total arterial revascualrization was achieved in 127 patients (85.8%). An average of 3.0 anastomoses/patient were construct ed, 2.8 of which were arterial. RA proximal anastomoses were placed on the IMA in 75% of cases, while direct anastomosis to the aorta (23.7% ) or to a saphenous vein (1.3%) was performed in the remainder. When a nastomosed to an IMA, the RA was subsequently infused intraluminally w ith 10 mg of papaverine (1 mg/mL). The target artery was the left ante rior descending or one of its branches in 14.7% of cases, the circumfl ex system in 76.3%, and the native right coronary or one of its branch es in the remaining 9%. An infusion of diltiazem (4 mg/hour) was start ed once the aorta was unclamped, and patients were maintained on oral diltiazem for 6 months postoperatively. Operative mortality was 1.4% ( 2 patients), with the additional late deaths from noncardiac causes. I n one patient there was a prolonged serous drainage from the RA donor site. Of the 144 survivors 140 are asymptomatic. Follow-up angiography demonstrated 100% early patency (< 30 days, 41 patients), and 94% lat e patency (6 to 20 months, mean 14 months, 30/32 patients). This study suggests the RA can be used safely as an alternative to saphenous vei n in coronary bypass surgery. These results are encouraging and warran t further clinical investigation.