Page 98 - Read Online

Page 14 of 18 Browne et al. Vessel Plus 2024;8:19 https://dx.doi.org/10.20517/2574-1209.2023.126

Figure 3. Illustration of single arterial grafting (SAG) and multiple arterial grafting (MAG) strategies for surgical revascularization
during CABG surgery. Participants of the ROMA trial are randomized to SAG or MAG groups (1:1 ratio). For simplicity, only one grafting
configuration is shown for each graft. LIMA: Left internal mammary artery; RA: radial artery; RIMA: right internal thoracic artery; Vein:
saphenous vein.

as speculated for the preceding ART trial). Additionally, there is no postoperative angiography planned to
directly evaluate the performance of the bypass grafts, which would complement the clinical outcomes and
result in a more robust evaluation of these arterial grafting strategies. We eagerly await the results of the
ROMA trial to clarify whether MAG reduces MACCEs and mortality and, importantly, whether secondary
conduit selection (radial artery, RIMA, or veins) influences these relationships.

CONCLUSION
Many surgeons have advocated for greater adoption of a second arterial graft to minimize long-term graft
failure rates and improve outcomes for CABG patients. At the moment, from both angiographic and clinical
outcomes perspectives, the radial artery is the preferable second conduit for patients with a reasonable life
expectancy undergoing isolated CABG surgery performed by experienced operators. Several observational
studies have recently reported suboptimal rates of RIMA graft failure with clinical outcomes often
comparable to or worse than saphenous veins. These results are concerning and reinforce the need to
replace assumptions of equivalence to LIMA with evidence from multi-center randomized trials to evaluate
the relative efficacy and safety of secondary RIMA use in CABG surgery. Greater adoption of arterial
grafting strategies is likely to come from high-quality evidence of benefit and safety from ongoing and
future large pragmatic trials with long-term angiography and clinical follow-up.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the review, as well as critical revision of the
article and final approval of the article: Browne A, Lamy A