**Conflict of interest**

The authors declare no conflict of interest.

*Right Internal Thoracic Artery with an Anteroaortic Course DOI: http://dx.doi.org/10.5772/intechopen.89807*

*The Current Perspectives on Coronary Artery Bypass Grafting*

offer for their patients with multivessel disease [29].

**4. Conclusion**

obtained with the use of BITA grafts are gender independent [26].

systematic use of BITA grafting among women remains unclear. Lately, some authors have shown that women had a similar 10-year survival compared to men when BITA grafting was used. Others have shown that women who underwent CABG in which BITA grafting was used had better survival than the group that used SITA, especially in patients older than 65 years. Thus, it was demonstrated that the best results

Several studies have shown that the use of bilateral in situ internal thoracic

Coronary artery bypass grafting using antegrade in situ RITA for LAD territory, compared to the in situ LITA, anastomosed in the same region, presents the same results in an evaluation period of 6 months, assessed by multislice coronary angiotomography, as demonstrated by some authors [1]. The results demonstrated 100% grafts' patency. The OPCAB surgery that used both ITAs for LC territory proved to be safe, effective, and feasible, even in patients with multivessel disease. The main reasons for the reluctance to use BITA grafts are its technical challenge, because it requires a high level of skill, experience, and concentration. The duration of surgeries is longer and may be associated with a minor increased risk of deep sternal wound infection in severe cases of diabetes, obesity, and/or chronic obstructive pulmonary disease. Another reason is the lack of convincing evidence of a randomized controlled trial. All these difficulties/problems can be overcome with the use of ITAs skeletonization. We should always bear in mind Lytle's statement made in 1999: "two internal thoracic artery grafts are better than one." Some studies already postulate the use of three arterial grafts in order to obtain better late

The CABG off-pump surgery leads to less cell injury than the conventional method of CABG surgery (on-pump) [1, 10, 19]. Based on randomized and observational trials that have compared off- versus on-pump CABG, there is one point that most surgeons would agree with the following: surgeons have to be experienced and routinely use off-pump techniques to have comparable results with off- versus on-pump CABG. The best results with off-pump CABG come from centers with

arteries provides excellent probabilities of event-free survival and cardiac event-free survival during follow-up of 15 and 20 years. More studies including elderly patients with severe comorbidities are needed. Results from studies with 15–20 years of total arterial revascularization suggest that cardiac surgeons should prefer total arterial grafts in order to reduce the risk of long-term cardiac events, especially during the second decade after surgery in relatively young and healthy patients. Despite the absence of a randomized control trial, there is evidence that the BITA graft is not only safe in the immediate postoperative period, but it has a supremacy over SITA use over long-term survival and absence of cardiac events. This is the reason why the use of RITA as a second arterial graft with LITA has acquired a Class IIa, evidence B indication at the European and American guidelines on myocardial revascularization [27, 28]. Total arterial revascularization using both ITAs is the best revascularization strategy that a cardiovascular community can

**138**

survival.

large volume of surgical patients [19].

The authors declare no conflict of interest.

**Conflict of interest**
