Comparison of the Safety of Right Internal Mammary Artery Versus Radial Artery for the Second Arterial Conduit During Coronary Artery Bypass Grafting

ObjectiveTo compare the safety of procedure in patients receiving right internal mammary artery (RIMA) versus radial artery (RA) as the second arterial graft during left internal mammary artery bypass surgery.MethodsA literature search was performed, and observational studies comparing RA and RIMA as a second arterial conduit were included. The end points included in-hospital mortality, sternal wound infection (SWI), myocardial infarction (MI), reoperation for bleeding, stroke and low cardiac output syndrome. Sensitivity analysis was performed, and publication bias was assessed.ResultsAnalysis of nine studies comprising 1,738 RIMA patients and 1,906 RA patients showed a similar risk of in-hospital mortality (relative risk [RR] 1.13, 95% confidence interval [CI] 0.64 to 1.98) between two groups. The risk of SWI in RIMA patients was significantly higher than that in RA patients (RR 3.19, 95% CI 1.64 to 6.20). The risk of the rest end points did not differ.ConclusionsThe postoperative risk seems to be similar between RIMA group and RA group, except the higher risk of SWI in RIMA patients. The surgeon relies on his own experience with these two arterial grafts and assessment of the patient profile to decide the choice of the second arterial conduit.