Comparison of RA and Saphenous Vein as the Third Conduit With BIMA in Coronary Bypass Surgery

In this 27-year single-center retrospective study, the authors compared radial artery (RA) vs saphenous vein graft (SVG) as the third conduit in patients receiving bilateral internal mammary arteries (BIMA) for coronary artery bypass grafting (CABG). Among 1,727 patients, 1,307 received BIMA + SVG and 420 received BIMA + RA. Propensity matching yielded 399 balanced pairs. Before matching, RA recipients had fewer comorbidities, including diabetes (14.8 percent vs 26.0 percent), hypertension (62.4 percent vs 77.7 percent), and renal impairment (5.5 percent vs 25.2 percent). In the matched analysis, the survival benefit was attenuated and not statistically significant (p=0.097), while renal complications were higher with RA (2.5 percent vs 0.5 percent; p=0.042). The authors conclude that RA may offer late benefits, but possible selection effects and renal risk warrant an individualized conduit choice.