Association between bilateral radial artery grafting and long-term survival after coronary artery bypass surgery.

OBJECTIVES: Radial artery (RA) is recommended as a graft for the second most important coronary target after the left internal thoracic artery-to-left anterior descending artery graft. This study assessed the survival benefit associated with bilateral RA use in coronary artery bypass grafting (CABG). METHODS: This was a retrospective analysis of prospectively collected data from a binational database including patients who underwent CABG with ≥2 grafts from 2001 to 2020. Patients were stratified into 3 groups: no RA (RA-0), single RA (RA-1), and bilateral RA (RA-2) use. Inverse probability of treatment weighting was used to adjust for baseline differences. The outcome analyzed was long-term all-cause mortality. RESULTS: Of the 59,608 patients included, there were 31,190, 22,741, and 5677 patients in the RA-0, RA-1, and RA-2 groups, respectively. The median postoperative follow-up was 5.0 years (interquartile range, 2.3-8.6 years), with a maximum follow-up of 17.9 years. Compared with RA-0, both RA-1 (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89) and RA-2 (HR, 0.74; 95% CI, 0.67-0.82) were associated with improved survival. RA-2 also demonstrated benefit over RA-1 use (HR, 0.87; 95% CI, 0.79-0.97). Inverse probability of treatment weighting was used to balance comparisons, and the proportional hazards assumption was satisfied (P = .10). Total arterial revascularization was achieved in 7.1%, 46.2%, and 81.0% of RA-0, RA-1, and RA-2 groups, respectively. CONCLUSIONS: Bilateral RA grafting was associated with superior long-term survival compared with the use of 1 RA or no RA conduit. Increased adoption of RA conduits in CABG is encouraged, and preservation of both RAs is recommended when CABG is anticipated.