Purpose: To achieve arterial myocardial revascularization we have progressively used more single, bilateral, internal thoracic artery (ITA) and radial artery (RA) grafts. We evaluated our early experience with bilateral radial artery-to-coronary grafts.

Methods: As part of their coronary reconstruction, 261 patients had 522 bilateral radial artery grafts from March 1995 to June 1997. Mean age was 61.1 years. There were 70 (27%) non-insulin dependent diabetics and 13 (5%) insulin dependent diabetics. Unstable angina was seen in 54 (21%) patients. Left ventricular ejection fraction <50% was noted in 74 (28.4%) patients. Coronary revascularization was completed with additional single ITA in 229 patients (88%), bilateral ITA in 25 patients (9.6%), and vein grafts in 13 patients (5%). Intra-luminal 1% papaverine in blood was used. There were 3.6±0.7 distal anastomoses per patient, with a total of 939. There were 921 (98%) arterial conduits, 18 with vein grafts. Of these, 594 (63%) of the anastomoses were with radial arteries. Of the 522 radial artery grafts 72 (13.8%) were used sequentially. The radial artery was most frequently placed to the circumflex marginals (261 patients, 100%), and posterior descending coronaries (169 patients, 65%). Proximal radial artery anastomosis to the aorta was done in 472 patients, the ITA in 42, another radial in 8. All anastomoses were constructed during a single cross-clamp period, mean 74.2±26.6 min.

Results: Operative mortality was 2 patients (0.8%). Complications included stroke in 2 patients (0.8%), deep sternal infection in 2 (0.8%), reoperation for hemorrhage in 1 (0.4%), and myocardial infarction in 2 (0.8%). Mean peak CKMB was 13.2±11.6 IU/L. There were no forearm infections or hand ischemia, but there were 4 (1.6%) hematomas, 1 requiring drainage. Angiography was done on 16 radial arteries at a mean of 4.2 months postoperatively. The imaging showed 20 of 22 distal anastomoses patent (91%), 1 sequential anastomosis occluded, and 1 string sign.

Conclusions: Bilateral radial artery-to-coronary grafting extends the scope of arterial myocardial revascularization, and it is safe. Late angiography results are required.