Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

Tuesday, November 15, 2016

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Source

Source Name: The New England Journal of Medicine

Source URL: http://www.nejm.org/doi/full/10.1056/NEJMoa1610021?query=featured_home

Author(s)

David P. Taggart, Douglas G. Altman, Alastair M. Gray, , Belinda Lees, Stephen Gerry, Umberto Benedetto and Marcus Flather

This editor hastes to submit to JANS this manuscript on the 5 year follow -up of the ART trial. It is guaranteed to be widely cited, probably hotly debated and certainly a disappointment to many of us!

We would not like to pre-empt the ctsnet readers' opinions on this important publication, but we are allowed to comment on the positive findings on skeletonisation, a technique I find has been somewhat controversial, and the methodological disappointment of more than 15 in a 100 subjects randomised to BIMA (BITA) not in fact receiving two arterial grafts!

I personally remember caring, operating and following-up early ART-enrolled patients in Edinburgh Scotland and look forward to the heated discussions this manuscript will immediately generate.

Comments

Submitted by Om Yadava on Fri, 2016-11-18 19:40

Why disappointment? Even at 5 years, survival curves are just about beginning to diverge. That's a positive thing. Survival advantage is not expected with either all vein revascularisation or PCI at 5 years, even there you need 10 years. I only hope ART trial follow up, though originally planned for 5 years, is extended to 10 years. Surely cross overs are a disappointment and I am sure communication gaps and ambiguity of guidelines and recommendations for use of Total Arterial Revascularisation and bilateral IMA's have a role to play for the net savvy patients . Guidelines writing committees must pay adequate attention to syntax ( as in grammar) in scientific documents and eschew such terms as ' may be' , ' can be considered ' etc.

Submitted by Aristotle Protopapas on Sat, 2016-11-19 04:09

Dear Dr. Yadava, Thank you on behalf of ctsnet for your most valid learned comments, especially from a proponent of arterial coronary revascularisation. We look forward to discussion and debate in this forum, hopefully with the author-members of ctsnet. As a personal opinion, I would hope that the well-known annual 10% attrition rate of venous bypass autogratfs would confer a survival benefit in patients receiving a RIGHT internal thoracic artery vascularized bypass flap.

Submitted by Federico Benetti on Sat, 2016-11-19 10:12

It is clear that The age and conditions of each patient are mandatory to decide any surgical thecnique .For older patients with shorter life expectancy a mammary to LAD operación minimally invasive MIDCAB or MINI OPCAB plus stents (Hybrid) or only with a good Medical treatment probable is enougth For a lot of this patients .Despiste this excelente trial ,many more good designed trials are needed to have The answer wich one is The best operación and treatment according with The characteristics of The coronary pathology and The patient