Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Aims: Compelling evidence encourages the use of the radial artery (RA) as the second arterial graft in coronary artery bypass grafting (CABG). However, its long-term benefits remain disputed. We sought to evaluate long-term outcome and survival by comparing patients receiving RAs with those receiving venous grafts to a single internal thoracic artery (ITA). Methods: We analyzed 345 patients undergoing primary multivessel CABG and conducted a 13-year long follow-up. In all, 187 patients received the RA and the left ITA as T-graft; 158 patients received saphenous veins complementing a single ITA. We performed propensity-score matching on 81 pairs to balance treatment selection and confounders. Results: Patients receiving RAs were younger and less likely to be female or to have pulmonary hypertension, impaired renal function, or left main coronary disease. At 30 days, they showed significantly lower unadjusted mortality and renal impairment. Unadjusted long-term survival was superior in the RA group, even after propensity-score matching. We found that RA use protected from late mortality. Conclusions: Using the RA and the left ITA as T-graft is associated with a significant long-term survival benefit in patients undergoing CABG. It may display a promising alternative to conventional use of a single ITA supplemented by saphenous veins.