Background
Total arterial revascularisation may prolong postoperative survival following coronary
surgery due to avoidance of late saphenous vein graft (SVG) failure leading to ischaemic
cardiac events. The left internal mammary artery (LIMA) is routinely used for CABG
but harvest may adversely affect lung function and reduce sternal vascular supply.
Early experience of a novel reconstruction with exclusive reliance on two radial arteries
(RA) joined as a Y graft (RARAY) is presented.
Methods
One RA is anastomosed to the ascending aorta and used to revascularise the left anterior
descending artery coronary territory; and a second RA is joined to the first 4–6 cm
from the origin, approximating the lateral border of the pulmonary artery and used
to revascularise the circumflex and right coronary territories. No LIMA is used. The
radial artery was harvested open with diathermy and metal clips and since 2008, all
patients received intravenous vasoconstrictors from the commencement of the anaesthetic.
Results
From 2002 to 2019, 28 patients underwent RARAY for specific indications of prior use
or reasons to avoid LIMA harvest, preservation of lung function, minimisation of bleeding
risk from antiplatelet agents and extra length of RA to graft distal coronary targets
beyond usual reach for LIMA. There was no RA spasm, no in-hospital death and no patient
returned with symptoms of angina.
Conclusions
The early experience of the RARAY operation for three coronary territory revascularisations
are satisfactory.
Keywords
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References
- The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study.Eur J Cardiothorac Surg. 2018; : 1-8
- Lung function following cardiac surgery is not affected by postoperative ventilation time.Ann Thorac Cardiovasc Surg. 2000; 6: 13-18
- Effect of internal mammary harvest on postoperative pain and pulmonary function.Ann Thorac Surg. 1993; 56: 1107-1109
- Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of the Society of Thoracic Surgeons National Cardiac Database.Circulation. 2009; 120: 935-940
- Bridgewater Keogh B. Kinsman R. Walton P. Sixth National Adult Cardiac Surgical Database Report 2008. Clinical Systems Limited, Oxfordshire, Dendrite2009
- The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study.Eur J Cardiothorac Surg. 2018; 54: 1093-1100
- Multiple arterial grafting is associated with better outcomes for coronary artery bypass grafting patients.Circulation. 2018; 138: 2081-2090
- Coronary artery bypass grafting with three arterial grafts does not improve outcomes compared to two arterial grafts at eight-year follow-up.Can J Cardiol. 2018; 34: S9-S10
- Second arterial versus venous conduits for multivessel coronary artery bypass surgery in California.Circulation. 2018; 137: 1698-1707
- Additional arterial conduits in coronary artery bypass surgery: finally coming of age.J Am Coll Cardiol. 2018; 71: 2974-2976
- Three arterial grafts improve late survival: a meta-analysis of propensity-matched studies.Circulation. 2017; 135: 1036-1044
- Total arterial coronary revascularization and factors influencing in- hospital mortality.Eur J Cardiothorac Surg. 1999; 16: 499-505
- A review of differing techniques of mammary artery harvesting on sternal perfusion: time for a randomized study?.Ann Thorac Surg. 2015; 100: 1942-1953
- Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts.J Thorac Cardiovasc Surg. 1985; 89: 248-258
- Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.N Engl J Med. 1986; 314: 1-6
- 21-Year survival of left internal mammary artery–radial artery–Y graft.J Am Coll Cardiol. 2018; 72: 1332-1340
- Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study).J Am Coll Cardiol. 2012; 60: 28-35
- Radial artery patency and clinical outcomes: five-year interim results of a randomized trial.J Thorac Cardiovasc Surg. 2003; 125: 1363-1371
- Radial artery versus saphenous vein patency randomized trial.Circulation. 2008; 117: 2859-2864
- Prevention of radial artery graft spasm: a survey of Canadian surgical centres.Can J Cardiol. 2003; 19: 677-681
- A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts.N Engl J Med. 2004; 351: 2302-2309
- Arterial revascularization in primary coronary artery bypass grafting: direct comparison of 4 strategies—results of the Stand-in-Y mammary study.J Thorac Cardiovasc Surg. 2009; 137: 1093-1100
- Clinical and angiographic effects of chronic calcium channel blocker therapy continued beyond first postoperative year in patients with radial artery grafts: results of a prospective randomized investigation.Circulation. 2001; 104: I64-I67
- Is postoperative calcium channel blocker therapy needed in patients with radial artery grafts?.J Thorac Cardiovasc Surg. 2005; 129: 532-535
- Effect of calcium-channel blocker therapy on radial artery grafts after coronary bypass surgery.J Am Coll Cardiol. 2019; 73: 2299-2306
- Calcium-channel blockers and radial artery grafting.J Am Coll Cardiol. 2019; 74: 1422
Article info
Publication history
Published online: June 16, 2020
Accepted:
May 1,
2020
Received in revised form:
April 6,
2020
Received:
January 4,
2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
