Modern views and approaches to the choice of grafts during coronary artery bypass grafting: basic concepts and terms in need of revision

Coronary artery bypass grafting remains a widespread and vital treatment for patients with multivessel coronary artery disease, especially diabetics. Despite the success of the surgery, the long-term outcome of coronary bypass grafting is influenced by the choice of used grafts. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. The long-term benefit of the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. Presently, there are discussions about which of the grafts is more effective and more durable, since the long-term functioning of the grafts makes it possible to protect patients from the risk of recurrent symptoms of coronary heart disease and the development of life-threatening complications. Each conduit has its own pathophysiological, anatomical and histological features, in our opinion, the combination of the radial and internal thoracic arteries under the term «autoarterial bypass surgery» and the analysis of these conduits in a single group can lead to incorrect interpretation of the data and the formation of unreliable conclusions