1. The Evidence For Conduit Choice
Rad
The Evidence For Conduit Choice
Joseph Zacharias
Lancashire Cardiac Centre
Blackpool Victoria Hospital

3. My Practice Total Cases 2004-2009: 459
Elective/ Urgent/ Emergency: 82.8%/15.3%/1.9%
Reoperation: Bleeding : 5%, Rewiring: 0.4%
Alive: Died in Hospital; 99.1%: 0.9%
Average Additive EuroSCORE: 3.43

4. My Practice LIMA usage: 445 cases (96.6%)
BIMA usage: 91 cases (19.82%)
RA usage: 19 cases (4.5%)
SVG usage: 420 cases (91.5%)
Cephalic Vein usage !!! : 2 cases (0.1%)

5. UK BIMA usage

7. LIMA vs SVG to LAD

8. IMA vs SVG to other targets

9. IMA vs SVG to other targets

10. Mammary artery Patency

11. Saphenous Vein graft Patency

12. Saphenous Vein graft Patency

13. Circulation. 2008 Sep 30;118(14 Suppl):S216-21.
Comparison of bilateral internal thoracic artery revascularization using in situ or Y graft configurations: a prospective randomized clinical, functional, and angiographic midterm evaluation.
Glineur D, Hanet C, Poncelet A, D'hoore W, Funken JC, Rubay J, Kefer J, Astarci P, Lacroix V, Verhelst R, Etienne PY, Noirhomme P, El Khoury G.

14. RITA patency was 74% (26/35)
Circulation Nov;90(5 Pt 2):II Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted. Chow MS, Sim E, Orszulak TA, Schaff HV. Section of Cardiovascular Surgery, Mayo Clinic, Rochester, MN

17. Randomized trial to compare bilateral vs
Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, Campbell H, Flather M; on behalf of the ART Investigators. Eur Heart J Aug 30.
Coronary artery bypass graft patients were enrolled in 28 hospitals in seven countries.
Three thousand one hundred and two patients were randomly assigned to SIMA (n = 1554) or BIMA (n = 1548). The mean number of grafts was 3 for both groups.
Forty per cent of the SIMA procedures and 42% of the BIMA were performed off-pump.
Mortality at 30 days was 18 of 1548 (1.2%) for SIMA and 19 of 1537 (1.2%) for BIMA, and at 1 year was 36 of 1540 (2.3%) and 38 of 1529 (2.5%), respectively.
The rates of stroke, myocardial infarction, and repeat revascularization were all </=2% at 1 year and similar between the two groups.
Sternal wound reconstruction was required in 0.6 and 1.9% of the SIMA and BIMA groups, respectively.

18. Radial artery 300 case series 2 randomised trials
RAPS trial (NEJM 2004)
RAPCO trial (JTCVS 2003)

19. Radial artery patency

23. Radial Vs SVG (Target stenosis)

24. Radial Vs SVG (target size)

25. Radial vs SVG

26. Effect of Peripheral Vascular disease

27. Gastroepiploic Artery

28. Gastroepiploic Artery

30. Effect of Conduit on re-intervention

31. Patients with Normal LV

32. Patients with Impaired LV

33. Effect of patient factors on reintervention

34. Effect of patient factors on reintervention

35. The effect of total arterial grafting on medium-term outcomes following coronary artery bypass grafting Jean-Francois Légaré , Ansar Hassan , Karen J Buth and John A Sullivan Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada Journal of Cardiothoracic Surgery 2007, 2:44doi: /

36. Conclusion LIMA = RIMA to LAD (.5 years)*
LIMA > SVG ( years)
RA > SVG (8 years)*
RA = FRIMA (<70) = SVG (>70) (6 years)*
RA > SVG in small vessels and probably females*
SVG > RA in target vessel stenosis < 80% & PVD*
SVG > GEA to RCA (except in vessels < 1mm)*
Patient factors have a big role to play.