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Early to Midterm Results With the Radial Artery in Coronary Artery Bypass Grafting Following Autotransplantation Without Pharmacological Manipulation

Abstract  Background: In our unit when the radial artery is used as a conduit for myocardial revascularization routine, postoperative calcium‐channel blockade is not practised. To preserve the radial artery, it is freed from the surrounding structures together with its venae commitantes and then left, in situ, in circulation, until needed for grafting. We evaluated the early to midterm patency of the radial artery using this strategy in our patients. Methods: We analysed prospectively collected data on 690 consecutive patients who had isolated primary coronary artery bypass grafting performed between June 1999 and February 2003 with at least one conduit being a radial artery. Results: Radial arteries were used for 851 of 2150 distal anastomoses (39.6%). Median follow‐up was 399 days (range 20–1323) and was 99.9% complete. Early mortality was 2.0% (14). Late mortality was 3.0% (21), 12 late deaths were not cardiac related. Nine patients (1.4%) had angiography on clinical grounds a mean of 238 days (range 0–511) postoperatively. Six coronary artery territories were inadequately supplied by their radial artery grafts. Kaplan–Meier event‐free survival was 94% and 90% at 1 and 3 years, respectively. Conclusions: The results of coronary artery bypass grafting using the radial artery in our institution compare favourably with those of other contemporary workers. It is safe to leave the radial artery in situ in the circulation until it is required for grafting. The absence of postoperative pharmacological manipulation of the radial artery does not appear to affect early or midterm outcome.