A randomized comparison of the Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial: One-year angiographic results and mid-term clinical outcomes

Abstract

The SV composite grafts were noninferior to the RITA composite grafts in terms of the 1-year angiographic patency rates.

Morphologic changes of the saphenous vein Y-composite graft based on the left internal thoracic artery: 1-year intravascular ultrasound study

“…A minimally manipulated SV composite graft based on the left ITA might result in advantageous negative SV graft remodeling during the first postoperative year. This remodeling and preserved endothelial function may have important roles in improving the patency rates of SV composite grafts as demonstrated in our recent study 23.…”

Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease

“…[19][20][21] We skeletonized almost exclusively the right internal thoracic artery, routed anterior to the ascending aorta across the midline, and anastomosed to the distal left anterior descending artery, in an in situ, individual graft fashion. We chose this approach because right internal thoracic artery grafting to the right coronary artery has been shown to fail more frequently than grafting to the left coronary areas, 16 and decreased midterm survival and reduced patency of composite grafts have been reported.…”

Commentary: Composite internal thoracic artery–saphenous vein grafts for coronary bypass: Can the two be used together?

“…These observations are in line with the prospective randomized SAVE RITA (A Randomized Comparison of the SAphenous VEin Versus Right Internal Thoracic Artery as a Y-Composite Graft) trial, previously published by the same authors. 6 The encouraging results reported by Hwang and colleagues should be interpreted with caution before widespread adoption of this technique. This was a retrospective study with an inherent selection bias.…”

“…Downstream exposure of the saphenous vein to active antithrombotic and anti-atherosclerotic substances such as nitric oxide, secreted by the ITA endothelium may account for this phenomenon. 1,6 In this regard, the practice of using an intraluminal metal instrument to destroy vein valves is controversial and, we believe, should be avoided altogether. Mechanical endothelial injury has been repeatedly shown to be a major predisposing factor for early graft failure.…”