Reply to the Editor:
First, we should not put total arterial and multiple arterial grafts in the same sentence and compare them with single arterial grafts but rather look at each graft individually. The conclusion of our manuscript
1
is that the left internal mammary artery and radial artery performed as expected, whereas vein grafts performed better than expected. However, high rates of right internal mammary artery (RIMA) failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in coronary artery bypass grafting surgery.- Alboom M.
- Browne A.
- Sheth T.
- Zheng Z.
- Dagenais F.
- Noiseux N.
- et al.
Conduit selection and early graft failure in coronary artery bypass surgery: a post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study.
J Thorac Cardiovasc Surg. June 2, 2022; ([Epub ahead of print])
The RIMA graft has a greater rate of failure due to the harvesting by the skeletonization technique, and this has been demonstrated in Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS)
2
,3
and Arterial Revascularization Trial (ART).4
Case closed. The in situ configuration (going behind the heart to the circumflex artery), in comparison with a Y graft coming from the left internal mammary artery, is associated with a lower patency in our manuscript but also with worse clinical outcomes in the reference provided by Prof Formica and his colleagues. They are correct saying this is a surgeon-related factor rather than a biological one. It is a technical problem, and we must fix it.The recent network analysis by Gaudino and colleagues
5
is compelling evidence that the right internal thoracic artery is not better than a vein and inferior to a radial artery. We must also keep in mind that vein grafts are better in recent trials than older trials, likely due to the use of cholesterol-reducing medication.While radial arteries have been tested in good trials, the best right internal thoracic artery configuration has not been demonstrated. There is an urgent need for a thorough evaluation of the patency and safety of the RIMA in coronary artery bypass grafting surgery, and surgeons should know their results and present them. It is an issue of intellectual integrity and patient safety.
References
- Conduit selection and early graft failure in coronary artery bypass surgery: a post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study.J Thorac Cardiovasc Surg. June 2, 2022; ([Epub ahead of print])
- Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS CABG study.J Am Coll Cardiol. 2019; 73: 121-130
- Skeletonized vs pedicled internal mammary artery graft harvesting in coronary artery bypass surgery: a post hoc analysis from the COMPASS trial.JAMA Cardiol. 2021; 6: 1042-1049
- Comparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the Arterial Revascularization Trial.JAMA Cardiol. 2021; 6: 1380-1386
- Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting.Eur J Cardio Thorac Surg. 2022; 62: ezac345https://doi.org/10.1093/ejcts/ezac345
Article info
Publication history
Published online: November 25, 2022
Identification
Copyright
© 2022 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse 
Elsevier's open access license policy
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Multiple and total arterial grafts are not a mirage anymore!JTCVS OpenVol. 13
- PreviewThe use of single arterial graft (SAG) is the most used technique for coronary artery bypass grafting (CABG), although a body of literature reports an increasing use of multiple (MAG) and total arterial graft (TAG).1,2 Unfortunately, the use of MAG/TAG is still underused, being reported between 10% and 35% in Europe and North America.3 Factors such as higher consuming time, greater prone to spasm, and technical harvesting lead surgeons to prefer SAG to MAG/TAG (Figure 1). In addition, the latest guidelines encourage percutaneous coronary intervention in 3-vessel coronary artery disease patients with limited coronary calcification and favor the use of CABG in patients with extensive coronary calcifications.
- Full-Text
- Preview
00386-2&id=fx1.jpg){kind=link}