Outcomes of Radial Artery versus Saphenous Vein as a Second Conduit after Coronary Artery Bypass Grafting.

Despite the advantages of multi-arterial grafting, saphenous vein (SV) configurations predominate in coronary artery bypass grafting (CABG). Additionally, benefits of radial artery (RA) utilization in multi-vessel CABG remain unclear. This study aims to compare the clinical outcomes of patients who received RA grafts during CABG to those who received SV grafts. A retrospective, single-institution cohort study was performed on 8,774 adults who underwent isolated coronary artery bypass surgery with multiple grafts between 2010-2022. Long-term postoperative survival was compared among RA and SV graft groups. Similarly, major adverse cardiac and cerebrovascular event (MACCE) rates were compared among both cohorts, with MACCE comprising death, myocardial infarction (MI), coronary revascularization, and stroke. Kaplan-Meier estimation and multivariable Cox regression were performed for both mortality and MACCE. A total of 7,218 (82.3%) patients who underwent multi-vessel CABG were included in this analysis. Of these patients, 341 (4.7%) received RA grafts and 6,877 (95.3%) received SV grafts secondary to LIMA use. Median BMI was significantly higher in patients who received RA grafts (p<0.001). There were no significant differences in operative mortality, new-onset renal failure, or mechanical ventilation. Median follow-up was 4.81 (2.3-7.5) years. Kaplan-Meier survival estimates were comparable at both the 1- and 5-year time points. On multivariable Cox regression, SV grafts were not significantly associated with an increased hazard of death (HR, 0.99; 95% CI:0.70-1.39; P=0.953), compared to the RA. However, SV grafting was associated with a lower hazard of MACCE (HR, 0.80; 95% CI:0.64-0.99; P=0.040). When assessing the individual components of MACCE, SV configurations were associated with a reduced need for revascularization when compared to RA, while no was difference observed for both stroke and MI. Overall, RA and SV secondary conduits for CABG were associated with comparable immediate postoperative complications and long-term survival. SV vs RA grafting was associated with a significantly decreased hazard of postoperative MACCE, likely due to lower rates of coronary revascularization.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.