title: The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting.
abstract: Internal thoracic arteries (ITAs) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated (class of recommendation [COR] I, level of evidence [LOE] B). As an adjunct to left internal thoracic artery (LITA), a second arterial graft (right ITA or radial artery [RA]) should be considered in appropriate patients (COR IIa, LOE B). Use of bilateral ITAs (BITAs) should be considered in patients who do not have an excessive risk of sternal complications (COR IIa, LOE B). To reduce the risk of sternal infection with BITA, skeletonized grafts should be considered (COR IIa, LOE B), smoking cessation is recommended (COR I, LOE C), glycemic control should be considered (COR IIa, LOE B), and enhanced sternal stabilization may be considered (COR IIb, LOE C). As an adjunct to LITA to LAD (or in patients with inadequate LITA grafts), use of a RA graft is reasonable when grafting coronary targets with severe stenoses (COR IIa, LOE: B). When RA grafts are used, it is reasonable to use pharmacologic agents to reduce acute intraoperative and perioperative spasm (COR IIa, LOE C). The right gastroepiploic artery may be considered in patients with poor conduit options or as an adjunct to more complete arterial revascularization (COR IIb, LOE B). Use of arterial grafts (specific targets, number, and type) should be a part of the discussion of the heart team in determining the optimal approach for each patient (COR I, LOE C).
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington. Electronic address: aldea@uw.edu.
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Aldea
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jay
authors.initials: J
authors.lastname: Pal
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fremes
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.affiliation: Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sabik
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
authors.forename: Todd
authors.initials: T
authors.lastname: Rosengart
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: The Society of Thoracic Surgeons, Chicago, Illinois.
authors.forename: Scott
authors.initials: S
authors.lastname: Firestone
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods* / Q000592:standards*; D024405:Gastroepiploic Artery / Q000637:transplantation; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation; D017534:Radial Artery / Q000637:transplantation