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They explore whether adding a radial artery or a saphenous vein as the third conduit during CABG with bilateral internal mammary (BIMA) yields a clear winner. The short answer is that long-term survival is identical for patients who undergo CABG with BIMA and either a radial artery or a saphenous vein as the third conduit. Strengths of this manuscript include the use of a propensity score to mitigate confounding issues in these 2 retrospective patient cohorts. The limitations include that the patient groups were small, and this is study is a single-center, retrospective study. However, the authors are to be commended for achieving outstanding long-term results with both cohorts—survival exceeding 75% in both groups at 15 years. To date, the use of the radial artery as a conduit is still below 15% in most large studies.
In my opinion, the results of this study likely relate to the strong protective effect that revascularization with BIMA exerts on a young population (average age 60 years). Stated differently, the use of BIMA dominated what additional benefit may or may not exist with use of a radial artery versus a saphenous vein for the third target vessel that was revascularized. The other very strong message in this manuscript speaks to the long-term survival afforded by CABG. Lastly, isn't it great that for those surgeons who have developed a strong affinity for the radial artery—that they can use this conduit with BIMA? Similarly, the workhorse of CABG—the reliable saphenous vein—stands up equally to the radial artery for those who prefer to use veins. We have a choice!
In summary, I think many surgeons have considered a variety of strategies to optimize revascularization with arteries and veins. I paraphrase what other cardiac surgeons have previously stated, “Tailor the operation to the patient.”
Long-term survival benefits of full arterial revascularization with radial artery (RA) used in addition to bilateral internal mammary arteries (BIMA) compared with saphenous vein (SV) used in addition to BIMA has not been clearly defined.