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.