Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy: Role of arterial versus vein conduits

Background. Coronary artery bypass grafting with concomitant coronary endarterectomy (CABG/CE) is used in patients with severe coronary atherosclerosis to revascularize otherwise ungraftable targets. This study investigates the efficacy of arterial versus vein grafting for CABG/CE surgery. Methods. We reviewed our experience in 288 CABG/CE patients ( 63 +/- 10 years, 207 men). A total of 1,056 grafts ( 275 internal thoracic artery [ ITA] [26%]; 221 radial [21%], 560 vein [53%]) were constructed including 325 (31%) placed to CE targets. Results. Eighteen of 288 patients died in-hospital (6.3%). Unadjusted one-year and five-year survival for the 270 discharged patients was 95.2% and 83.0%, respectively. Survival ( 0 to 7 years) was significantly better for patients with radial (n = 154) versus no-radial ( n = 134) artery grafting ( p = 0.021). Multivariate Cox regression analysis associated increased number of arterial grafts ( hazard ratio [HR] = 0.64 [0.44 to 0.92]; HR [95% confidence interval]) to improved survival, while RCA endarterectomy (HR = 1.8 1.0 3.3; p = 0.054) was associated with worse survival. Repeat angiography ( 495 days [ median]) in 68 patients encompassed 78 CE ( 38 vein, 24 ITA, and 16 radial) and 162 non-CE ( 84 vein, 40 ITA, and 38 radial) grafts. Graft failure was similar ( p = 0.37) for radial ( 10 of 54 [19%]) and ITA ( 7 of 64 [11%]), and worst for vein ( 50 of 122 [41%]; p < 0.001). For CE targets, graft failure was worse for vein (55% vs 35%; p = 0.05) and unchanged for arterial (13% vs 15%; p = 0.88) grafts. Conclusions. Combined CABG/CE is associated with good long-term outcomes. Increased arterial grafting achieved by radial artery utilization confers a survival benefit in this high-risk population. The latter is probably derived from superior radial versus vein graft patency.