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J Thorac Cardiovasc Surg 2003;126:5-6
© 2003 The American Association for Thoracic Surgery

Editorial

Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio,USA

Received for publication December 20, 2002; accepted for publication February 11, 2003.

^* Address for reprints: Bruce W. Lytle, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, #F-25, Cleveland, OH 44195, USA
lytleb@ccf.org

The first 20% of the full text of this article appears below.

The left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) graft is now a fundamental part of operations for coronary revascularization. There is a mountain of observational evidence that this strategy produces short- and long-term outcomes that are superior to a vein graft–only strategy. The LITA-LAD graft has higher early and later patency rates than vein grafts and decreases the risk of early and late death. A lesser, but increasingly substantial, body of evidence from multiple institutions appears to show that bilateral ITA grafting improves outcomes relative to a single ITA graft strategy. Reactivation of the use of the radial artery (RA) as a bypass graft has provided the option of substituting the RA for the right internal thoracic artery (RITA) as a second arterial bypass graft.

There are many potential advantages of using the RA instead of the RITA graft. The RA is larger and easier to work with than the RITA, its preparation is straightforward, can be accomplished during the LITA dissection, and using the RA instead of the RITA avoids any increase in sternal wound complications associated with bilateral ITA grafting. However, it is not known whether substituting the RA for the RITA as a second arterial graft provides similar revascularization outcomes to a bilateral ITA strategy. Is the RA as good a coronary bypass graft . . . [Full Text of this Article]