SAN DIEGO – April 30, 2018 – The findings of a new study has the potential to change the way coronary bypass surgery is currently performed around the world. The study, conducted by the Radial Artery Database International Alliance (RADIAL), and presented in a plenary session of the American Association for Thoracic Surgery’s 98th Annual Meeting, found the use of the radial artery, rather than vein graft, resulted in significantly lower incidence of adverse cardiac events up to five years after CABG.
Coronary artery bypass grafting (CABG) is one of the most commonly performed major operations with approximately one million procedures performed annually worldwide. CABG has been proven to be highly effective at curing angina and improving life expectancy in most patients with three vessel coronary artery disease. Most such patients need three bypass grafts and this is usually performed with one artery from the chest (internal thoracic artery: ITA) and two veins from the leg. There is growing evidence from large observational studies that the use of a second arterial graft can further improve long-term outcomes for CABG. However there no hard evidence from randomized trials (which, by eliminating any potential bias, provide the highest quality of scientific evidence) has been published to support this.
The RADIAL study combined individual patient data from all six randomized trials that have compared the use of supplemental radial artery or saphenous vein to the ITA during CABG. In RADIAL, by pooling together data from more than 1300 patients in the six individual studies, for the first time it was shown that the use of the radial artery, rather than vein graft, resulted in a significantly lower incidence of adverse cardiac events up to five years after CABG.
“This is the first randomized-based demonstration of a definitive important clinical benefit using the radia artery over the saphenous vein for coronary bypass surgery. The radial artery make the operation relatively easier compared to other arteries, and I believe that our results have the potential to change practice” says presenting author Mario Gaudino, MD, of Weill Cornell Medicine and New York Presbyterian.
The differences in clinical outcomes were due to markedly superior angiographic patency of the radial artery at five years. Furthermore, as the failure rate of vein grafts, but not the radial artery, accelerates after five years it is possible that the clinical benefits of the radial artery could become even greater with further follow-up. These results have the potential to change the way coronary bypass surgery is currently performed all around the world.
Senior Author, Professor David Taggart from Oxford University and RADIAL explains, “Apart from the obvious clinical benefits of the radial artery over vein graft at five years, the question of whether this could also eventually translate into a survival benefit over the longer term with continuing attrition of vein grafts remains an important possibility and will be the subject of future research.”
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The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premiere association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1400 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit www.aats.org to learn more.
Professor Mario Gaudino (Cornell, NY)
“This is the first randomized-based demonstration of a definitive important clinical benefit using the radial artery over the saphenous vein for coronary bypass surgery. The radial artery make the operation relatively easier compared to other arteries, and I believe that our results have the potential to change practice”