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J Thorac Cardiovasc Surg 2003;125:782-783
© 2003 The American Association for Thoracic Surgery

Editorials

Complete arterial grafting for coronary artery disease?

From the Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.

Received for publication Sept 23, 2002. Accepted for publication Oct 21, 2002. Address for correspondence: Brian F. Buxton, MD, Department of Cardiac Surgery, Austin & Repatriation Medical Centre, Austin Campus, HSB-5, Studley Rd, Heidelberg, Victoria 3084, Australia.

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See related article on page 826.

Muneretto and colleagues ¹ demonstrated excellent results in patients having total arterial compared with conventional arterial and venous grafting for coronary artery disease in a prospective randomized study. Free arterial grafts are being used increasingly to replace the saphenous vein as a conduit to avoid the late complications of vein graft atherosclerosis. The aim is to prevent major ischemic complications and reoperation. To date, increased complexity, safety, and efficacy concerns have limited the acceptance of extensive or complete arterial grafting. Symptom-directed angiography and late clinical follow-up suggest that the benefits of arterial versus venous grafting have become more obvious with time. Well-constructed and well-conducted prospective randomized controlled trials are therefore very important to define the benefits, if any, and which patients should receive only arterial grafts.

These authors have included a wide range of patients but excluded those with diabetes, obesity, lung disease, and steroids, in whom the risks of sternal ischemia and infection are considered to be high. The information from randomized clinical trials should not be applied universally but rather be confined to similar subsets of patients. In the series by Muneretto and colleagues, ¹ there were few patient exclusions, and therefore these results are relevant to most clinical . . . [Full Text of this Article]

Related Article

Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation

Claudio Muneretto, Alberto Negri, Jacopo Manfredi, Alberto Terrini, Giulia Rodella, Suad ElQarra, and Gianluigi Bisleri
J. Thorac. Cardiovasc. Surg. 2003 125: 826-835. [Abstract] [Full Text] [PDF]

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