Radial artery graft function is not affected by age

Objective

Extensive arterial grafting with the radial artery in elderly patients is still debated, because of the reduced life expectancy and the supposedly higher periprocedural morbidity caused by an accelerated atherosclerosis of arterial grafts in elderly patients, which might hamper functional results.

Methods

We reviewed our experience with patients undergoing radial artery myocardial revascularization (coronary artery bypass grafting) between January 2003 and December 2006, divided into 2 groups: elderly patients (≥70 years, group A) and young patients (≤60 years, group B). Hospital outcome and transit-time flowmetric maximum and mean flow, pulsatility index, and graft flow reserve were compared. Results were stratified by target vessel, surgical technique, and subgroups at risk.

Results

Hospital outcome, troponin I levels, and echocardiographic segmental kinetics were comparable in the 2 groups. Stratifying patients for target vessels, no differences in radial artery transit-time flowmetric results were recorded between the 2 groups either on-pump or off-pump, as free grafts or Y grafts, or in diabetic patients and hypertensive patients. Although graft flow reserve was significantly improved in all patients (P < .05 in the young and elderly groups, regardless of the target vessel, the surgical technique, and the comorbidities), graft flow reserve of radial artery grafts was comparable between elderly and young patients.

Conclusions

Radial artery coronary artery bypass grafting showed similar transit-time flowmetric functional results in elderly and young patients, regardless of the target vessel, the use or avoidance of cardiopulmonary bypass, the construction of proximal anastomoses, and the presence of comorbidities. These data explain the reported better results of arterial revascularization in the elderly and suggest an increase in extensive radial artery grafting in the last decades of life.

CTSNet classification: 17, 23, 31

Abbreviations and Acronyms: EF, ejection fraction, GFR, graft flow reserve, IABP, intra-aortic balloon pump, LITA, left internal thoracic artery, OPCABG, off-pump coronary artery bypass grafting, PI, pulsatility index, RA, radial artery, SVG, saphenous vein graft, TTF, transit-time flowmetry, WMSI, wall motion score index