The radial artery in coronary re-operations

Objectives: Vein graft (VG) failure often leads to coronary re-operation (r e-do coronary artery bypass grafting (CABG)). As the internal thoracic arte ry (ITA(s)) and VG have often already been used and as the VG has usually f ailed, the radial artery (RA) is ideally suited for use in re-do CABG. We e valuated our experience where the RA(s) was a key conduit in re-do CABG to determine the safety and efficacy and compared this to re-operations where the RA was not used. Methods: Three hundred and fifty-two consecutive patie nts who had re-do CABG using the RA(s) from July 1995 to March 1999 were st udied: mean age 67.3 years, 209 (60%) angina Class III or IV, past acute my ocardial infarction (AMI) in 201 (57%), left ventricular ejection fraction <50% in 109 (31%). Five hundred and thirty-two RAs were used bilateral in 1 88 (51%) patients). Additionally, 232 new left ITAs (66% of patients) and 7 1 new right ITAs (20% of patients) were placed. A total of 1022 distal anas tomoses were performed (mean of 2.9 per patient). Follow-up was at 1 month, 3 months, and yearly. The results were also compared to 730 patients havin g re-do CABG without an RA (January 1990 to June 1995) using identical oper ative and myocardial protection techniques. Results: RA spasm was noted int ra-operatively in four (1.1%) patients, operative mortality was noted in 14 (3.9%) patients, peri-operative myocardial infarction was noted in ten (2. 8%) patients, intra-aortic balloon pump was used in nine (2.6%) patients, s troke was noted in six (1.7%) patients, deep sternal infection was noted in two (0.6%) patients, and re-operation for haemorrhage was performed in sev en (2.0%) patients. There was only one (0.3%) forearm infection, and two (0 .6%) forearm haematomas required drainage. There was no hand ischaemia. Whe n compared to 730 re-do CABG patients without RA, there were significant di fferences in arterial grafts used (2.6 vs. 1.2, P = 0.01), in deep sternal infection (0.6% vs. 2.6%, P = 0.01) and donor site infection (0.3% vs. 2.7% , P = 0.005! favouring the RA group. Three-year actuarial survival was 89.2 % in the RA group and 88.5% in the non-RA group (P = 1.0). Conclusions: Use of the RA in re-do CABG is safe, effective, allows additional conduit choi ce, reduces donor site and sternal infections, and may avoid further late V G failure. <(c)> 2001 Elsevier Science B.V. All rights reserved.