Thorac Cardiovasc Surg 2012; 60 - V67
DOI: 10.1055/s-0031-1297457

6 Year patency of the radial artery graft to the right coronary artery. Influence of positioning the radial artery pedicle

M Doss 1, P Risteski 1, M Thudt 1, D Serio 1, A Moritz 1
  • 1J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany

Objectives: The supporting veins and the fascia in the pedicled radial artery graft provide stability but restrict length and thus can cause kinking of the artery when the unflexible fascia is placed on the outer curvature of a bend. Especially when bypassing the right coronary artery, the graft is predisposed to kink over the acute margin of the heart.

We aimed to determine the role of positioning the radial artery graft pedicle on patency rate and clinical outcomes.

Methods: From 2004–2005, 100 patients underwent coronary bypass grafting of the right coronary artery with a pedicled radial artery graft. With regards to the position of the pedicle two groups were evaluated: supine group n=50 (fascia facing epicardium), prone group n=50 (fascia facing sternum).

The patients in both groups were comparable with regards to preoperative and intraoperative data. All patients were followed up using standard mailed questionnaire and the patency rate was assessed using 64-sliced multidetector computed tomography or cardiac catheterisation.

The mean follow up was 6 years.

Results: Follow up was 100%. 89 patients were available for angiographic follow up. Survival was 100%. There were no cases of myocardial infarction or re-operation in this group of patients. 3 patients had re-interventions for occluded radial artery grafts. Graft patency at 6 years, of the radial artery in the prone position was 91.5% versus 97.6% in the supine position (p=0.04%). Overall 6 year patency for the radial artery was 94%, for the internal thoracic artery 92.8% and the great saphenous vein 96.4%.

Radial artery graft occlusion of patients with coronary artery stenosis <70% was significantly higher p=0.017, than in patients with stenoses >70%.

Conclusions: Overall patency of the radial artery graft to the right coronary artery is excellent at 6 years. The position of the radial artery graft fascia (pedicle) significantly influences patency rate.