Korean Circ J.  2012 Feb;42(2):107-112. 10.4070/kcj.2012.42.2.107.

Comparison of the Radial Artery and Saphenous Vein as Composite Grafts in Off-Pump Coronary Artery Bypass Grafting in Elderly Patients: A Randomized Controlled Trial

• Song SW
• Sul SY
• Lee HJ
• Yoo KJ

• KMID: 1826382
• DOI: http://doi.org/10.4070/kcj.2012.42.2.107

Abstract

BACKGROUND AND OBJECTIVES
Arterial grafts have a better long-term patency rate than saphenous vein (SV) when used in off-pump coronary artery bypass surgery (OPCAB). However, arterial grafts in elderly patients are often diseased. We sought to compare the early outcomes achieved by using the two different types of composite grafts.
SUBJECTS AND METHODS
We conducted a randomized trial to compare radial artery (RA) and SV composite grafts based on the in situ left internal mammary artery in 60 elderly (>70 years old) patients, who were scheduled to undergo OPCAB. Clinical outcomes and 1-year postoperative CT angiography results were compared. The quality of the conduit was evaluated by employing vascular ultrasonography, optical coherence tomography (OCT), and histologic examination.
RESULTS
No differences in immediate postoperative morbidity and mortality were observed between the two groups. Early postoperative CT angiography revealed a SV patency rate of 100%, which was not different from that of RA composite grafts (99.1%). CT angiography after a year showed an overall patency rate of 96.3%. The overall patency rate of the SV group at 1 year was 94.7%, which was similar to that of the RA group (97.4%). Also, there was no difference in overall survival rate between the two groups. Vascular ultrasonographic images showed strong correlations between OCT and histopathology.
CONCLUSION
Our analysis of early outcomes revealed that the SV could be used as an alternative composite graft to the RA in elderly patients. Vascular ultrasonography is an accurate, real-time, and reproducible method for assessing the quality of the RA conduit.

Keyword

Coronary artery bypass grafting; Saphenous vein; Radial artery

MeSH Terms

Aged
Angiography
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Humans
Mammary Arteries
Radial Artery
Saphenous Vein
Survival Rate
Tomography, Optical Coherence
Transplants

Figure

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  Fig. 1 Construction of a composite graft with either the radial artery or saphenous vein based on the left internal mammary artery. LIMA: left internal mammary artery, LAD: left anterior descending artery, OM: obtuse marginal branch, Dx: diagonal branch, VD: vessel disease, RCA: right coronary artery.

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