Expert Systematic Review on Conduit Choice for CABG Endorsed by EACTS and STS

Thursday, October 26, 2023

Submitted by

EACTS Staff

Source

Source Name: European Journal of Cardio-Thoracic Surgery

Source URL: https://doi.org/10.1093/ejcts/ezad163

Author(s)

Gaudino M, Bakaeen FG, Sandner S, Aldea GS, Arai H, Chikwe J et al

The authors performed a systematic review of the evidence supporting the use of different conduits for CABG. Their overall conclusion was that coronary artery bypass grafting strategy must be individualized. The radial artery (RA) graft has better patency rates and fewer adverse cardiac events compared with saphenous vein graft (SVG). Right internal thoracic artery (RITA) patency shows no clear evidence of superiority over SVG. Observational studies suggest that RITA may be superior to SVG in terms of survival time and outcomes. However, the only randomized trial was neutral. There is limited data on use of the right gastroepiploic artery and more evidence is needed on endoscopic vein harvesting. No-touch SVG harvesting was found to have better patency rates than traditional SVG harvesting.

Comments

Submitted by Yiannis Chlorogiannis on Sat, 2023-10-28 04:04

Dear colleagues I read carefully the article “Expert Systematic Review on Conduit Choice for CABG Endorsed by EACTS and STS” I am afraid that it is a totally WRONG message to conclude that “RITA may be superior to SVG in terms of survival time and outcomes” when at the same time everyone agrees that “LITA IS Superior to SVG “. LITA and RITA are IDENTICAL in every anatomical and physiological aspect. I believe that it would be more appropriate to say that harvesting and anastomosing RITA (usually to Circumflex) requires more technical demands and a more complex learning curve than LITA to LAD but if it is successful it will be for the benefit of the patient. The degree of this difficulty unveiled and appeared on the ART trial were one out of seven patients had a misharvested RITA inappropriate to be used ! Also it is meaningless to support that SVG is superior to RITA and at the same time to agree that SVG is inferior to Radial Artery graft and RA is inferior to LITA (to be anastomosed to LAD). Therefore I strongly recommend, if technically feasible, Total Arterial Myocardial Revascularization using Both Internal Thoracic Arteries (in situ) with a Radial Artery. The quality of those Arterial Grafts may reflect a superiority than Vein Grafts both in survival and quality of life. IOANNIS CHLOROGIANNIS MD, PhD Director of Department of Cardiac Surgery and Center of Excellence of Total Arterial Myocardial Revascularization Euroclinic of Athens, Greece