INTRODUCTION
The use of left internal thoracic artery(LITA) in grafting of the left
anterior descending artery(LAD) provides undisputable advantage in
patient undergoing coronary artery bypass
grafting(CABG)1-3. Tremendous success of the LITA
graft encouraged use of the other arterial conduits such as right
internal thoracic(RITA) or radial artery(RA). The concept of full
arterial revascularization in grafting of the non-LAD vessels was coined
in an attempt to further improve survival in patients following
multivessel CABG. Several observational studies as well as meta-analyses
reported a survival benefit with RITA or RA used as a second arterial
graft4-8. Yet, the adoption of multiple arterial
grafting remains unsatisfactory ranging between 4% to
32%5,9-10. Despite the reported benefit of the full
arterial grafting, the Arterial Revascularization Trial(ART) found no
survival benefit in the intention-to-treat analysis at 5–and 10–years
outcomes between bilateral(BITA) and single internal thoracic arteries.
However the high cross-over rate and the use of RA could have introduced
a systemic error to the results11.
Equivocal long-term results of the randomized trial in addition to
reported increased risk of sternal wound infection in patients with
BITA12as well as technical complexity associated with
using multiple arterial grafts led to inconclusive results on whether
the use of second arterial graft is safe and associated with improved
short- and long-term outcomes. The aim of this study was to assess the
effect on short-term outcomes and long-term survival in patients
following CABG between second arterial conduit(RITA or RA) and saphenous
vein and between RITA and RA as second best arterial conduit.