THE RADIAL ARTERY STUDY - EFFECT OF RADIAL ARTERY HARVEST ON QUALITY OF LIFE - A RANDOMISED STUDY
D. O'Donnell*, D.L. Hare, J. Raman, B.F. Buxton
Austin & Repatriation Medical Centre, Heidelberg, Victoria.
Background: Patient perceptions and acceptance of radial artery harvest site and hand function, following coronary bypass surgery, are unknown.
Methods: In a prospective study assessing the radial artery (RA) in addition to the left internal mammary artery for coronary surgery, randomisation of the second graft was stratified into two tiers.
Gp 1: age <70, diabetics <60 years: RA vs right internal thoracic artery
Gp 2: age >70, diabetics >60 years: RA vs saphenous vein
Results: 110 patients (pts) had assessment of quality of life (QOL) using the Cardiac Depression Scale (CDS) and the Quality of Graft Harvest Site (QGH) questionnaire pre-operatively and at 12 months (mths).
|
RA (n = 59) |
Non-RA (n = 51) |
P (2-tail) |
|||
|
Pre |
12/12 |
Pre |
12/12 |
T (test) |
|
|
CDS |
76.8 |
70.2 |
72.3 |
58.7 |
0.028 |
|
QGH |
9.4 |
11.65 |
9.1 |
12.5 |
0.334 |
Changes over 12 months in the younger and older pts were compared.
|
Gp 1 (n = 21) |
Gp 2 (n = 19) |
P (2-tail) |
|||
|
Pre |
12/12 |
Pre |
12/12 |
T (test) |
|
|
CDS |
71.8 |
72.5 |
74.0 |
58.1 |
0.045 |
|
QGH |
9.3 |
13.2 |
9.1 |
9.8 |
0.01 |
40 pts receiving RA grafts were also assessed at 3 mths for hand strength by dynamometer and hand vascularity, as digital brachial index (DBI) using photoplethysmography, comparing operated with non-operated arm.
|
Control |
Observed |
Control |
Observed |
T (test) |
|
|
Strength |
42.0 |
35.8 |
30.0 |
31.5 |
0.004 |
|
DBI |
1.01 |
0.94 |
1.02 |
0.96 |
0.462 |
Correlation of strength and DBI was poor with a coefficient of 0.26.
Conclusions: Patients receiving RA grafts had worse QOL scores at 12 mths. Following RA harvest, younger pts had worse QOL and perceived worse graft site function than older pts. This paralleled reduced strength in the operated arm, unassociated with changes in hand vascularity.
