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• W2120393740 abstract "Although in their recent article Navia and colleagues1Navia D. Vrancic M. Piccinini F. Camporrotondo M. Thierer J. Gil C. et al.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.J Thorac Cardiovasc Surg. 2014; 147: 632-638Google Scholar concluded that their study provided evidence for the superiority of the free right internal thoracic artery (RITA) graft compared with the radial artery (RA) during total arterial revascularization off-pump coronary artery bypass grafting, their data do not support this sweeping conclusion. In fact, their study showed no differences in operative mortality, perioperative complication rates, and intermediate Kaplan Meier-survivals between the propensity matched RITA and RA groups. The unmatched comparisons are not relevant because of the very significant heterogeneity between the groups. Their evidence of the RITA superiority is thus based only on the observed significant difference in the combined postoperative reintervention and readmission rates. Navia and colleagues1Navia D. Vrancic M. Piccinini F. Camporrotondo M. Thierer J. Gil C. et al.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.J Thorac Cardiovasc Surg. 2014; 147: 632-638Google Scholar did not specify the actual rates of reintervention or readmission, nor did they elucidate the events resulting in reintervention or readmission. Late events were also retrospectively gathered from “direct communication with the patient, their family, and attending physician,” a less than ideal means of follow-up. Complications that often result in readmission are not reported. What were the rates of sternal infection, stroke, respiratory failure, renal failure, reoperation for bleeding, and myocardial infarction in the matched patients? What were the rates of recatheterization, and what was the graft patency? Readers need to have a better sense of exactly what events contributed to the difference in individual and combined reintervention and readmission rates. Readers also need to decide whether a better combined reintervention and readmission rate defines “superiority” of the RITA when there are no differences in perioperative adverse events or survival between the matched patients? Finally, a very important issue is that the authors seem to have abandoned RA grafting and thus had very few patients in the RA group (only 8 of 149, or 5% of the matched group) in the last half of their 8½ year study. Why the change? What were the RA antispasm protocols? Was the RA used to bypass target vessels only with greater than 70% stenosis? What was the mode of RA graft failure? Were there graft failures at the end-to-side anastomosis of the RA to left internal thoracic artery? Was there consistency in the RA harvest technique and the harvesting personnel? The answers to these questions might help to clarify whether the harvesting technique, the deployment, or the surgical technique of RA grafting contributed to the differing reintervention and readmission rates. Navia and colleagues1Navia D. Vrancic M. Piccinini F. Camporrotondo M. Thierer J. Gil C. et al.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.J Thorac Cardiovasc Surg. 2014; 147: 632-638Google Scholar are to be commended for their efforts attempting to define the second best arterial graft during CABG. Their study does not, however, support their conclusion that the RITA is superior to the RA. Most other studies comparing RITA and RA, in fact, have shown better or equivalent event-free survival with the RA.2Caputo M. Reeves B. Marchetto G. Mahesh B. Kim K. Angelini G. Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes.J Thorac Cardiovasc Surg. 2003; 126: 39-47Google Scholar, 3Hayward P.A. Hare D.L. Gordon I. Matalanis G. Buxton B.F. Which arterial conduit? Radial artery versus free right internal thoracic artery: six-year clinical results of a randomized controlled trial.Ann Thorac Surg. 2007; 84 (discussion 497): 493-497Google Scholar, 4Nasso G. Coppola R. Bonifazi R. Piancone F. Bossetti G. Speziale G. Arterial revascularization in primary coronary artery bypass grafting: direct comparison of 4 strategies—results of the stand-in-Y Mammary Study.J Thorac Cardiovasc Surg. 2009; 137: 1093-1100Google Scholar In addition, we5Tranbaugh R.F. Dimitrova K.D. Lucido D.J. Hoffman D.M. Dincheva G.R. Geller C.M. et al.The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery.J Thorac Cardiovasc Surg. 2014; 147: 133-142Google Scholar recently showed that RA grafts have similar patency to RITA grafts and that RA grafting resulted in fewer perioperative adverse events, with similar early and late survivals to RITA grafting. The debate thus continues; however, most of the literature supports RA grafting as an excellent alternative to RITA grafting. This appears to be especially true for patients who are older or have chronic obstructive pulmonary disease or diabetes. 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 studyThe Journal of Thoracic and Cardiovascular SurgeryVol. 147Issue 2PreviewThe aim of our study was to evaluate the long-term outcome of patients exclusively undergoing total arterial revascularization off-pump coronary artery bypass grafting and to compare the performance of the radial artery and the right internal thoracic artery as a second conduit. Full-Text PDF" @default.
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• W2120393740 title "Free right internal thoracic artery graft versus radial artery during total arterial revascularization off-pump coronary artery bypass grafting: Truly superior?" @default.
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