Whatever happens, two mammary is better than one

Area of Science:

• Cardiovascular Surgery
• Vascular Grafting
• Arterial Conduits

Background:

• The left internal mammary artery (LIMA) is the primary choice for arterial grafting.
• Alternative arterial conduits, including the right internal mammary artery (RIMA) and radial artery (RA), are considered, especially for patients under 70.
• Grafting the radial artery (RA) requires good distal vessel run-off.

Purpose of the Study:

• To evaluate the selection criteria and challenges associated with arterial conduits in coronary artery bypass grafting.
• To highlight the advantages and limitations of LIMA, RIMA, and RA as arterial grafts.

Main Methods:

• Review of established surgical practices and literature regarding arterial conduit selection.
• Analysis of factors influencing the choice between LIMA, RIMA, and RA.
• Consideration of technical aspects and patient-specific conditions.

Main Results:

• LIMA remains the first-choice conduit due to its established efficacy.
• RIMA and RA are viable alternatives, with RA suitability dependent on adequate run-off.
• Technical difficulties in harvesting the RIMA are a significant consideration.

Conclusions:

• Arterial conduits, particularly LIMA, RIMA, and RA, play a crucial role in coronary artery bypass grafting.
• Patient age and distal vessel status are key factors in conduit selection.
• Technical feasibility, especially for RIMA harvesting, must be addressed.