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

Authors

Garry W Hamilton, Justin Ren, David M Chye, Colin Royse, Andrea Bowyer, Siven Seevenayagam, Christopher M Reid, David L Hare, Omar Farouque, Alistair Royse

Published in

JTCVS open. Volume 32. Pages 101940. Epub Jun 24, 2026.

Abstract

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).
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.
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.
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.

PMID:
42604366
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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