Continuing Conundrum of Multiple Arterial Conduits for Coronary Artery Bypass Grafting
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The idea of using multiple arterial grafts (AGs) for coronary artery bypass graft surgery (CABG) dates back more than 4 decades, and the potential clinical benefits of this strategy represent one of the most extensively studied aspects of coronary surgery. A recent MEDLINE search for studies comparing the results of CABG using bilateral versus single internal thoracic artery (BITA versus SITA) resulted in 3950 articles. Over the years, the BITA versus SITA comparison has been summarized in 6 meta-analyses, with the most recent pooling data from 89 399 patients (20 949 with BITA and 68 450 with SITA). All of them reported significantly longer survival associated with the use of BITA, with the hazard ratio for mortality varying from 0.78 to 0.81.1
The findings are similar when the second AG is the radial artery. Multiple observational studies have reported significantly longer survival associated with the use of the radial artery in addition to the SITA.2 This has been observed even in high-risk categories such as female sex, obesity, diabetes mellitus, and reoperations.2
It is important to emphasize, however, that the great majority of the reported evidence supporting multiple AGs is observational.
To date, only 3 randomized …