Searching for the second-best coronary artery bypass graft: is it the radial artery?

Virtually all cardiac surgeons and their referring cardiologists know that the most effective and reliable coronary artery bypass conduit is the pedicled internal thoracic (mammary) artery (LITA) when placed to the left anterior descending artery coronary artery (LAD). This first choice of bypass graft conduits is based on convincing evidence of improved survival in patients with critical LAD disease in whom an LITA graft has been placed.1,2 The importance of an LITA graft when bypassing the LAD is so well accepted that it is now used as a quality indicator in the assessment of the performance of cardiac surgery programs in coronary artery bypass graft surgery (CABG).3