Revascularization Guidelines Series-Radial Grafts and Off Pump Surgery

Video Transcription

Video Summary

In this video, the speaker discusses two surgical issues: the use of the radial artery as a conduit for coronary artery bypass grafting (CABG) and the role of off-pump CABG surgery. Regarding the radial artery, the speaker presents evidence from a meta-analysis of randomized trials showing that the radial artery, along with the no-touch saphenous vein, has a significantly better patency rate compared to the traditional saphenous vein. They also note a patient-level meta-analysis showing that the use of the radial artery is associated with a reduction in major cardiac events and repeat revascularization. However, they highlight that the radial artery should be used selectively, considering factors such as completeness of the palmar arch and target vessel stenosis. <br /><br />Moving on to off-pump CABG surgery, the speaker explains that while this technique aims to avoid the use of cardiopulmonary bypass, it has been associated with higher technical complexity and lower patency rates. They present data from a meta-analysis showing better mortality outcomes with on-pump surgery compared to off-pump. However, the speaker also acknowledges that off-pump surgery may be beneficial for certain patients, particularly those at high risk of respiratory complications. They emphasize the importance of surgeon expertise and experience in determining the success of off-pump surgery. The speaker also mentions the potential advantage of off-pump surgery in reducing neurological risk. Overall, they recommend using off-pump surgery selectively, particularly for high-risk patients at risk of stroke, and when performed by experienced surgeons. <br /><br />The summary is based on a transcript of a video by Dr. Domenico Pagano, posted on the YouTube channel of European Association for Cardio-Thoracic Surgery.

Asset Subtitle

Mario F. Gaudino MD, PhD, MSCE

Keywords

radial artery

coronary artery bypass grafting

off-pump CABG surgery

saphenous vein

patient-level meta-analysis