Saphenous Vein Graft vs. Radial Artery Graft: Searching for the Best Second Conduit in Coronary Artery Bypass Grafting

Objective: To compare early in hospital outcomes between Radial Artery (RA) graft and saphenous vein grafts (SVG) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery. Study Design: Quasi Experimental study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Oct 2021-Nov 2024. Methodology: Three hundred and ninety-one patients with over age of 18 years, regardless of gender who underwent isolated On-pump CABG were recruited through non probability consecutive sampling. Patients were non-randomly allocated into two groups; Group-A (LIMA+VG) and Group-B (LIMA+RA+VG). Data on demographic, preoperative, intraoperative, and postoperative characteristics was collected using a structured proforma from adult cardiac surgery database. In-hospital outcomes and post-operative complications were compared between the study groups. Results: Out of 391 patients, 76(19.4%) were females and 315(80.6%) were males with median age of 59.00(52.00-65.01) years. Group-A and Group-B had 182(46.5%) and 209(53.5%) patients respectively. Group-A had longer ICU stay duration compared to Group-B [45.50(22.00-91.00) vs. 29.00(21.00-61.00) hours; p<0.01]. In patients receiving three grafts, Group-A showed significantly higher chest tube drainage than Group-B [550.00(380.00-990.00ml) vs. 400.00(250.00-650.00ml); p=0.013]. The OR for type of graft was 2.03 (95% CI: 0.98-4.19; p=0.05), manifesting the borderline but significant impact on the postoperative complications. Conclusion: RA grafts showed potential advantages over SVG as the second conduit in CABG surgery, especially in improving early in-hospital outcomes. Our findings emphasize the potential of RA graft use and support its frequent adoption in clinical practice particularly in younger population.