Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival.

OBJECTIVE: Whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined.

METHODS: Study population included a selected low-risk group of 275 subjects undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 489 undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 75%. We finally obtained 275 propensity score-matched pairs for comparison.

RESULTS: Operative mortalities were 1 (0.3%) and 2 (0.7%) for BITA+RA and BITA+SV, respectively (P = .56). After mean follow-up of 10.6 ± 4.8 years, BITA+RA survivals were 97.4% ± 0.9%, 90.3% ± 2.0%, and 81.7% ± 3.2% at 5, 10, and 15 years, respectively, versus 97.0% ± 1.0%, 94.1% ± 1.5%, and 82.1% ± 3.4% (log-rank P = .54; hazard ratio, 1.16; 95% confidence interval, 0.71-1.9). Strategies showed comparable survivals when RA or SV was used to graft the right (P = .79) or left (P = .55) coronary system only. Lack of survival advantage for BITA+RA was confirmed in patients 60 years and younger (P = .80) and older than 60 years (P = .53), with and without diabetes mellitus (P = .89 and P = .54, respectively), and with or without left ventricular dysfunction (P = .95 and P = .65, respectively).

CONCLUSIONS: Long-term survival in selected low-risk patients undergoing BITA grafting was not extended by using RA as third arterial conduit in preference to SV.