%0 Journal Article
%T Quality improvement initiative to increase radial artery usage as a second arterial conduit in coronary artery bypass grafting.
%A Moya-Mendez ME
%A DeLaura I
%A Thornton SW
%A Williams AR
%A Zwischenberger BA
%J Interdiscip Cardiovasc Thorac Surg
%V 38
%N 5
%D 2024 May 2
%M 38652599
暂无%R 10.1093/icvts/ivae068
%X <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.