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Page 12 of 16 Harik et al. Vessel Plus 2023;7:30 https://dx.doi.org/10.20517/2574-1209.2023.124

The decision of which arterial graft should be used in women is also distinct from the decision-making
process in men. Bilateral ITA grafting in women has been associated with sternal wound infection [96,102] ; a
retrospective study of 2,979 CABG patients (10% women) found that women who received BITA had a
higher incidence of postoperative mediastinal infection compared with men who received BITA (3.3% vs.
1.5%; P = 0.02). In addition, the same study found that the benefit of using the RA as the second arterial
graft was heightened in women (HR 0.51, 95%CI: 0.36-0.72) compared with men (HR 0.84,
95%CI: 0.61-1.05) .
[19]

[103]
Lastly, women remain underrepresented in CABG trials , calling into question the applicability of the vast
majority of cardiovascular and cardiac surgery evidence. In a recent study-level meta-analysis of sex
[104]
differences in SVG patency, no difference between the sexes was found (incidence rate ratio 0.96,
95%CI: 0.90-1.03; P = 0.24), but more importantly, out of the 234 studies assessed in the final stage of
screening, 100 were excluded as they did not report outcomes by sex, while an additional 44 studies had
enrolled less than 10 women. Clearly, higher quality and more robust data are needed to guide graft
selection in women.

CONCLUSIONS
The choice of the graft to use in CABG can influence the efficacy of the surgery and the clinical benefits that
the patient derives from CABG. There are many considerations for the choice of CABG graft: patency of the
graft, its associated clinical outcomes, the amount of native coronary artery stenosis, the planned target
vessel, and technical considerations such as harvesting and anastomotic techniques. In addition, the baseline
characteristics and risk profile of the individual patient in which the graft is used should be accounted for in
order to provide the best patient-centered care.

DECLARATIONS
Authors’ contributions
Conceptualization, writing, research, revision: Harik L
Writing, revision, conceptualization: An KR
Research, revision, writing: Dimagli A, Dell'Aquila M
Research, writing: Perezgrovas-Olaria R, Soletti G Jr
Research, writing, editing: Rossi C
Research, revision: Cancelli G, Leith J
Editing, conceptualization, revision, writing: Gaudino M

Availability of data and materials
Not applicable.

Financial support and sponsorship
Harik L is partially supported by a grant from the National Heart, Lung, and Blood Institute: T32-
HL160520-01A1).

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.