Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery

Long-term results of coronary artery bypass surgery using the internal thoracic and radial arteries

Authors: O.A. Kovalenko, D.E. Musin, K.V. Krymov, M.D. Alshibaya

Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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UDC: 616.132.2-089.843:616.134.5+616.134.31

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (4): 299-305

Quote as: Kovalenko O.A., Musin D.E., Krymov K.V., Alshibaya M.D. Long-term results of coronary artery bypass surgery using the internal thoracic and radial arteries. Clinical Physiology of Circulation. 2019; 16 (4): 299–305 (in Russ.). DOI: 10.24022/1814-6910-2019-16-4-299-305

Received / Accepted:  30.08.2019/19.09.2019

Full text:  


Coronary artery bypass grafting (CABG) remains one of the most effective methods of treatment for patients with coronary artery disease. Selection of the appropriate conduit for the bypass is key to achieving good short- and long-term procedural outcomes. The use of arterial grafts other than the left internal thoracic artery (ITA) to the left anterior descending coronary artery for CABG remains very uncommon. In a recent report on nearly 1.5 million CABG procedures, the rates of use of both ITA and radial arteries (RA) for grafting in the United States were 4.9% and 6.5%, respectively. The fact that a multiple-arterial grafting strategy is associated with better clinical outcomes and higher patency rates that would justify the greater technical difficulty, longer operative times, and potential complications. However, the long-term results of CABG are few and reflect medium-term results.
The paper presents a clinical study of the patency of arterial (ITA and RA) conduits and a shunt from great saphenous vein (GSM) in one patient over a 16-year observations. These data are confirmed by the results of instrumental studies (coronary angiography, echocardiography). During the observed period, the patient strictly adhered to standard drug therapy. On the coronarography, it was found that for 16 years there has been a functional patency of bypass from the ITA and RA. And GSM bypass was occluded. Performing angioplasty and stenting of this coronary artery. It should be noted that one of the main criteria for the satisfactory function of bypass is the preservation of the corresponding circulation pools.
The results of this dynamic observation of the viability of conduits over a 16-year period indicate the need for widespread use of arterial conduits.


  1. Shapira O.M. Radial artery as the preferred second conduit for coronary bypass. New Engl. J. Med. 2018; 378 (22): 2134–35. DOI: 10.1056/NEJMe1804750
  2. Carpentier A., Guermonprez J.L., Deloche A., Frechette C., DuBost C. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts. Ann. Thorac. Surg. 1973; 16: 111–21. DOI: 10.1016/S0003-4975(10)65825-0
  3. Carpentier A. Discussion of Geha A.S., Krone R.J., Mc-Cormick J.R.: Selection of coronary bypass: anatomic, physiologic, and angiographic considerations of vein and mammary artery grafts. J. Thorac. Cardiovasc. Surg. 1975; 70: 414–31.
  4. Curtis J.J., Stoney W.S., Alford Jr W.C., Burrus G.R., Thomas Jr C.S. Intimal hyperplasia: a cause of radial artery aortocoronary bypass graft failure. Ann. Thorac. Surg. 1975; 20: 628–35. DOI: 10.1016/S0003-4975(10) 65754-2
  5. Acar C., Jebara V.A., Portoghese M., Beyssen B., Yves Pagny J., Grare P. et al. Revival of the radial artery for coronary artery bypass grafting. Ann. Thorac. Surg. 1992; 54 (4): 652–9. DOI: 10.1016/0003-4975(92) 91007-v
  6. Gaudino M., Tondi P., Benedetto U., Milazzo V., Flore R., Glieca F. et al. Radial artery as a coronary artery bypass conduit: 20-year results. J. Am. Coll. Cardiol. 2016; 68 (6): 603–10. DOI: 10.1016/j.jacc.2016.05.062
  7. Tatoulis J., Buxton B.F., Fuller J.A. Patencies of 2127 arterial to coronary conduits over 15 years. Ann. Thorac. Surg. 2004; 77: 93–101. DOI: 10.1016/S0003-4975(03) 01331-6
  8. Hosono M., Murakami T., Hirai H., Sasaki Y., Suehiro S., Shibata T. The risk factor analysis for the late graft failure of radial artery graft in coronary artery bypass grafting. Ann. Thorac. Cardiovasc. Surg. 2019; 25 (1): 32–8. DOI: 10.5761/atcs.oa.18-00054
  9. Schwann T.A., Al-Shaar L., Tranbaugh R.F., Dimitrova K.R., Hoffman D.M., Geller C.M. et al. Multi versus single arterial coronary bypass graft surgery across the ejection fraction spectrum. Ann. Thorac. Surg.2015; 100: 810–7. DOI: 10.1016/j.athoracsur.2015.02.111
  10.  Baikoussis N.G., Papakonstantinou N.A., Apostolakis E. Radial artery as graft for coronary artery bypass surgery: advantages and disadvantages for its usage focused on structural and biological characteristics. Review J. Cardiol. 2014; 63: 321–8. DOI: 10.1016/ j.jjcc. 2013.11.016
  11. Royse G., Royse C.F., Tatoulis J., Grigg L.E., Shah P., Hunt D. et al. Postoperative radial artery angiography for coronary bypass surgery. Eur. J. Cardiothorac. Surg. 2000; 17: 294–304. DOI: 10.1016/S1010-7940(99)00364-4
  12. Gao J., Stead S., Lee R.M. Papaverine induces apoptosis in vascular endothelial and smooth muscle cells. Life Sci. 2002; 70: 2675–85. DOI: 10.1016/S0024-3205(02) 01525-4

About Authors

  • Oleg A. Kovalenko, Dr. Med. Sc., Leading Researcher;
  • Dzhanybek E. Musin, Cand. Med. Sc., Leading Researcher;
  • Konstantin V. Krymov, Researcher;
  • Mikhail D. Alshibaya, Dr. Med. Sc., Professor, Head of Department of Surgical Treatment of Coronary Heart Disease;

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