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James Tatoulis of the Royal Melbourne Hospital in Australia presents the case for choosing the radial artery (RA) as a second or third graft in coronary artery bypass surgery. He discusses the benefits of RAs over saphenous veins and highlights technical considerations for optimal success with RA grafts.
This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational programs.
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Tatoulis, James (2017): Total Arterial Revascularization: The Case for Radial Artery Conduit. CTSNet, Inc. https://doi.org/10.25373/ctsnet.5559265Retrieved: 19:59, Nov 02, 2017 (GMT)
2 Comments
Fantastic data on the radial artery, putting it in the proper perspective. Congratulations on the 20 + years experience with the radial artery.
At the very end we get the relevant slide, ie patency per territory. Alas, the vein results are missing. The vein data results are for all territories and include diagonals, ramus, etc. So we still do not prove better patency for the radial vs vein, as we need to compare apples with apples. Since the proposal is to use the radial on the right but only if native stenosis is tight, how do veins do under this specific scenario?? No data.
In the end, if the right coronary graft occludes, then we have a patient of single vessel disease, that vessel being the right. How many single right vessel disease patients are symptomatic anyway and how many come to need surgery?? That is why I find it very difficult to accept that BIMA+RA vs BIMA+SVA has a 9% survival advantage at 10 years. These data need some careful scrutiny.
However, for me the only interesting data is that for the OM territory the radial does just as well as the right mammary. So, for those concerned with taking the RIMA down, this is good news. Still, we have no clarification if the RA to OM data was in targets with severe stenosis or all comers.