Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft

OBJECTIVE: We sought to evaluate whether the radial artery (RA) provides the same clinical and angiographic results when proximally anastomosed to the aorta or to the left internal thoracic artery (ITA) as a composite Y-graft. METHODS: From February 1999 to December 2002, 512 patients underwent myocardial revascularization using the RA, the left ITA and, when required, the saphenous vein. According to the surgeons' preference the RA was proximally anastomosed to the aorta [336 patients (65.6%), Ao-Cor group] or to the left ITA as a composite Y-graft [176 patients (34.4%), Y-graft group]. There was a significant prevalence of three-vessel disease (86.8 versus 73.2%, (P = 0.000) and elderly age (60+/-9 versus 58+/-8 years, (P = 0.014) in the Y-graft group. RESULTS: Patients in Y-graft group had longer aortic cross clamp time (P = 0.001), more bypass grafts per patient (P < or = 0.001) more arterial bypass grafts per patient (P < or = 0.001) and more bypass grafts per patient with the RA (P < or = 0.001). There were no differences in terms of perioperative outcome. Mean follow-up time was 27.1+/-11.7 months in 322/333 (96.7%) patients of the Ao-Cor group and 14.9+/-10.2 in 165/172 (95.9%) patients of the Y-graft group. There was no difference in terms of overall survival (P = 0.75) cardiac event-free survival (P = 0.65) RA patency rate at postoperative angiography (P = 0.59) and during follow-up (P = 0.93). A preoperative coronary artery stenosis < or = 70% was related with competitive flow (P = 0.000) at postoperative angiography and with RA occlusion (P = 0.001) at follow-up angiography. CONCLUSIONS: The RA provides the same clinical and angiographic results both as aorto-coronary and composite Y-graft with the left ITA. When the RA is used as Y-graft the procedure is more technically demanding and a greater number of distal coronary anastomoses is possible. RA grafts to targets with stenosis < or = 70% appear to be at risk of failure