Radial artery as a conduit for coronary artery bypass grafting: a state-of-the-art primer

Although the impact of RA on mortality is still unproved, ‘patient-level’ meta-analysis of the Radial Artery Database International Alliance has brought additional support for the use of the RA in coronary surgery providing solid evidence of a better patency of the RA compared with the SV and suggesting the possibility of better outcomes associated with its use. Much has been learned in the past 50 years of CABG practice about the use and behaviour of arterial and venous grafts, but we are still learning and further research is needed. Unfortunately, we do not have a strong evidence base for selecting bypass grafts, beyond great confidence in the left ITA to the LAD and superior arterial conduit patency. A large confirmatory trial on the use of multiple versus single arterial grafts for coronary bypass is currently under way (randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA Trial) [19]. Until the results of ROMA are available, a selection of the second (and third) coronary graft will be guided by patient characteristics, coronary disease patterns and centre/operator experience.