Mid-term results of radial and mammary arteries as the conduits of choice for complete arterial revascularization in elective and nonelective coronary bypass surgery

OBJECTIVE: The aim of this study is to evaluate the mid-results of the use of the radial artery alongside the internal mammary artery for complete arterial revascularization in elective and nonelective coronary bypass graft surgery. METHODS: All patients undergoing coronary artery surgery alone over a 3-year period with disease of more than one coronary artery were considered for complete arterial revascularization. Preoperatively, all patients had an Allen's test on the dominant arm and a cutoff point of 10 seconds was used. These patients were initially followed in the outpatient clinic after 6 weeks and then further followed up with the help of a mailed questionnaire. The incidence of recurrent angina and reangiogram was obtained and selected patients were further interviewed and examined in the outpatient department. RESULTS: Over a 3-year period, 291 patients underwent total arterial revascularization using the radial and internal mammary arteries alone in Y-graft configuration. The mean age of the study population was 62.4 +/- 8.8 years, with a male to female ratio of 221 to 70. Elective surgery was performed in 230 patients (79.4%), with nonelective procedures comprising a total of 61 patients (20.6%). The mean number of distal anastomoses was 2.9 +/- 0.9. There were four perioperative mortalities (1.37%) and 43 patients (14.7%) developed low cardiac output syndrome, requiring inotropes with or without intra-aortic balloon pump. Forty patients (13.7%) developed postoperative supraventricular arrhythmias. There was no incidence of hand ischemia or wound complications. After a mean follow-up period of 35.4 +/- 6.3 months of 220 patients (75%), there was one further death and 24 patients required readmissions for cardiac-related causes. Ten patients had reangiogram for angina of which one patient had a blocked radial artery graft and two patients underwent angioplasty to their native coronary arteries. The patients' angina score was currently 0.5 +/- 1.0 versus 2.6 +/- 1.4 preoperatively. CONCLUSION: Total arterial revascularization with the internal mammary and radial artery is associated with a low rate of perioperative complications and mortality and can be safely used in both elective and nonelective bypass graft surgery with excellent clinical results.