PDF(Pubmed)
Abstract：
OBJECTIVE: Use of radial artery as a second arterial graft, compared to a saphenous vein, in coronary artery bypass grafting (CABG) can improve late outcomes. However, the radial artery remains underutilized. We initiated a quality improvement (QI) initiative to increase the usage of radial artery grafts.
METHODS: During our 4-month lead period, we disseminated evidence for radial artery graft usage to surgeons, developed a radial artery decision-making algorithm and adopted endoscopic harvesting. Our QI initiative was conducted over a 6-month period and included a postoperative survey of decision-making for graft selection and obstacles to radial artery usage.
RESULTS: Over the 6-month study period, 247 patients received isolated CABG which included 98 (40%) with radial arteries as a second arterial graft and 144 (58%) with greater saphenous veins. Radial artery usage increased with QI initiative implementation by 67% compared to 6 months prior to the study period (60 radial arteries/252 isolated CABG, 24%) (P = 0.006). The survey response rate was 93% (231/247). Barriers to radial artery graft usage were poor quality target vessel or stenosis <80% (24%), patient age >75 years (20%), ejection fraction ≤35% (8%) and renal insufficiency/dialysis (7%). No patients experienced significant complications from radial artery harvest.
CONCLUSIONS: Our institutional QI initiative was successful in (i) increasing the usage of radial artery as a second arterial graft and (ii) understanding barriers to radial artery graft usage. Implementation of a QI program can improve radial artery usage in CABG with low risk of patient morbidity from radial artery harvest.
METHODS: During our 4-month lead period, we disseminated evidence for radial artery graft usage to surgeons, developed a radial artery decision-making algorithm and adopted endoscopic harvesting. Our QI initiative was conducted over a 6-month period and included a postoperative survey of decision-making for graft selection and obstacles to radial artery usage.
RESULTS: Over the 6-month study period, 247 patients received isolated CABG which included 98 (40%) with radial arteries as a second arterial graft and 144 (58%) with greater saphenous veins. Radial artery usage increased with QI initiative implementation by 67% compared to 6 months prior to the study period (60 radial arteries/252 isolated CABG, 24%) (P = 0.006). The survey response rate was 93% (231/247). Barriers to radial artery graft usage were poor quality target vessel or stenosis <80% (24%), patient age >75 years (20%), ejection fraction ≤35% (8%) and renal insufficiency/dialysis (7%). No patients experienced significant complications from radial artery harvest.
CONCLUSIONS: Our institutional QI initiative was successful in (i) increasing the usage of radial artery as a second arterial graft and (ii) understanding barriers to radial artery graft usage. Implementation of a QI program can improve radial artery usage in CABG with low risk of patient morbidity from radial artery harvest.
摘要：
目的：使用桡动脉作为第二动脉移植物，与隐静脉相比，冠状动脉旁路移植术（CABG）可以改善晚期结局。然而,桡动脉仍未得到充分利用.我们发起了一项质量改进（QI）计划，以增加桡动脉移植物的使用。
方法：在我们四个月的提前期，我们向外科医生传播了使用桡动脉移植物的证据，开发了一种桡动脉决策算法，并采用内窥镜采集。我们的QI计划进行了六个月的时间，其中包括对移植物选择和桡动脉使用障碍的决策进行的术后调查。
结果：在六个月的研究期间，247例患者接受了孤立的CABG，其中98例（40％）以桡动脉作为第二动脉移植物，144例（58％）大隐静脉。与研究前6个月相比，随着QI计划的实施，桡动脉使用量增加了67%(60条桡动脉/252条孤立的CABG，24%)(P=0.006)。调查应答率为93%(231/247)。桡动脉移植物使用的障碍是目标血管质量差或狭窄<80％（24％），患者年龄>75岁（20%），EF≤35％（8％）和肾功能不全/透析（7％）。没有患者出现桡动脉收获的并发症。
结论：我们的机构QI计划在以下方面取得了成功：1）增加桡动脉作为第二动脉移植物的使用；2）了解桡动脉移植物使用的障碍。实施QI计划可以改善CABG中桡动脉的使用，同时降低患者从桡动脉收获的发病率。
方法：在我们四个月的提前期，我们向外科医生传播了使用桡动脉移植物的证据，开发了一种桡动脉决策算法，并采用内窥镜采集。我们的QI计划进行了六个月的时间，其中包括对移植物选择和桡动脉使用障碍的决策进行的术后调查。
结果：在六个月的研究期间，247例患者接受了孤立的CABG，其中98例（40％）以桡动脉作为第二动脉移植物，144例（58％）大隐静脉。与研究前6个月相比，随着QI计划的实施，桡动脉使用量增加了67%(60条桡动脉/252条孤立的CABG，24%)(P=0.006)。调查应答率为93%(231/247)。桡动脉移植物使用的障碍是目标血管质量差或狭窄<80％（24％），患者年龄>75岁（20%），EF≤35％（8％）和肾功能不全/透析（7％）。没有患者出现桡动脉收获的并发症。
结论：我们的机构QI计划在以下方面取得了成功：1）增加桡动脉作为第二动脉移植物的使用；2）了解桡动脉移植物使用的障碍。实施QI计划可以改善CABG中桡动脉的使用，同时降低患者从桡动脉收获的发病率。
