Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score–matched follow-up study

Abstract

The results of our study provide evidence for the superiority of the right internal thoracic artery graft compared with the radial artery as a second conduit in total arterial revascularization off-pump coronary artery bypass grafting.

Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit

“…Controversy still remains, on whether the use of the RA as second arterial conduit achieves the same long-term benefits as that documented with the use of the RITA [5][6][7][8][9][10][11][12]. The lack of clear evidence, the potentially increased sternal wound complication rate and the perceived technical complexity by using bilateral internal thoracic arteries often result in the RA as the preferred second conduit of choice [1].…”

“…To date, only a single randomized controlled trial (RCT) [3] has been published in the literature, largely underpowered to detect any difference in long term survival between RITA and RA groups. Several observational studies comparing RITA versus RA have been reported with conflicting findings [5][6][7][8][9][10][11][12]. Propensity score matching (PSM) based analysis of observational data is emerging as an attractive alternative in view of paucity of evidence from RCT, and can be relied upon as evidence when RCTs are not possible [4].…”

Current State-of-the-art of Coronary Artery Bypass Surgery

“…64,74,75) Even though they are all muscular arteries, the ITA is more similar in properties to an elastic artery and is resistant to arteriosclerosis and spasms. 66,75,76) However, radial artery and gastroepiploic artery grafts are likely to cause arteriosclerosis and spasms, which are complications characteristic to muscular arteries. Histologically, the radial artery also differs from the ITA in that it has a thicker media comprised of smooth muscle.…”

“…A number of studies have investigated the patency rate of radial artery grafts, 65,74,76,77) and the results vary. A meta-analysis of five studies showed no remarkable superiority of radial artery grafts over SVGs, due to string phenomenon that occurs with the former.…”

Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

“…Most recent studies reported better outcomes after use of BITA grafts, especially in the younger population. [1][2][3][4][5] However, some studies reported higher rates of surgical site infection (SSI) after use of BITA grafts because of the decreased blood supply to the sternum and surrounding tissues. [6][7][8] Previous studies investigating the feasibility of using BITA grafts in elderly patients included patients aged >65 or >70 years, [9][10][11][12] but the feasibility of using BITA grafts specifically in octogenarians has not previously been investigated.…”