• Robert F Tranbaugh, Thomas A Schwann, Daniel G Swistel, Kamellia R Dimitrova, Laila Al-Shaar, Darryl M Hoffman, Charles M Geller, Milo Engoren, Sandhya K Balaram, John D Puskas, and Robert H Habib.
• Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, New York. Electronic address: rft9008@med.cornell.edu.
• Ann. Thorac. Surg. 2017 Aug 1; 104 (2): 553-559.

BackgroundIt is not clear whether radial artery (RA), right internal thoracic artery (RITA), or saphenous vein (SV) is the preferred second bypass graft during coronary artery bypass graft surgery using the left internal thoracic artery (LITA) in patients aged less or greater than 70 years.MethodsLate survival data were collected for 13,324 consecutive, isolated, primary coronary artery bypass graft surgery patients from three hospitals. Cox regression analysis was performed on all patients grouped by age.ResultsAdjusted Cox regression showed overall better RA versus SV survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p < 0.001); and RITA patients aged less than 70 years also had a survival benefit compared with SV (HR 0.86, p = 0.03). There was no difference in survival for RA versus RITA across all ages.ConclusionsFor patients aged less than 70 years, the optimal grafting strategy is using either RA or RITA as the second preferred graft. In patients aged 70 years or more, RA and RITA grafting should be used selectively. Multiple arterial grafting using either RA or RITA should be more widely utilized during coronary artery bypass graft surgery for patients less than 70 years of age.Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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