BILATERAL RADIAL ARTERY GRAFTS IN CORONARY RECONSTRUCTION - TECHNIQUEAND EARLY RESULTS IN 261 PATIENTS

Background. To achieve arterial myocardial revascularization we have p rogressively used more single and bilateral internal thoracic artery a nd radial artery (RA) grafts. We evaluated our early experience with b ilateral radial artery to coronary grafts. Methods. As part of their c oronary reconstruction, 261 patients had 522 bilateral RA grafts from March 1995 to June 1997, Mean age was 61.1 years. There were 70 (27%) patients with non-insulin-dependent diabetes and 13 (5%) with insulin- dependent diabetes. Unstable angina was seen in 54 (21%) patients. Lef t ventricular ejection fraction less than 50% was noted in 74 (28.4%) patients. Coronary revascularization was completed with additional sin gle internal thoracic artery in 229 patients (88%), bilateral internal thoracic artery in 25 patients (9.6%), and vein grafts in 13 patients (5%), Intraluminal 1% papaverine in blood was used. There were 3.6 +/ - 0.7 distal anastomoses per patient, with a total of 939, 921 (98%) w ith arterial conduits and 18 with vein grafts. Five hundred ninety-fou r (63%) of the anastomoses were with RAs. of the 522 RA grafts 72 (13. 8%) were used sequentially. The RA was most frequently placed to the c ircumflex marginals (261 patients, 100%) and posterior descending (169 patients, 65%). Proximal RA anastomosis was directly to the aorta in 472 patients, the internal thoracic artery in 42, or another RA in 8. All anastomoses were constructed during a single cross-clamp period (m ean, 74.2 +/- 26.6 minutes). Results. Operative mortality was 2 patien ts (0.8%). Complications included stroke in 2 patients (0.8%), deep in ternal infection in 2 (0.8%), reoperation for hemorrhage in 1 (0.4%), and myocardial infarction in 2 (0.8%). Mean peak creatine kinase-MB wa s 13.2 +/- 11.6 IU/L. There were no forearm infections or hand ischemi a, but there were 4 (1.6%) hematomas, 1 requiring drainage. Angiograph y was done on 16 patients with RA grafts, a mean of 4.2 months postope ratively. Twenty of 22 distal anastomoses were patent (91%), and there was 1 occlusion and 1 string sign. Conclusions. Bilateral RA to coron ary grafting extends the scope of arterial myocardial revascularizatio n, and is safe. Late angiographic results are required. (Ann Thorac Su rg 1998;66:714-20) (C) 1998 by The Society of Thoracic Surgeons.