Reply: In Be-“Twix”: A BIMA argument
2020; Elsevier BV; Volume: 161; Issue: 1 Linguagem: Inglês
10.1016/j.jtcvs.2020.06.132
ISSN1097-685X
Autores Tópico(s)Cardiac Valve Diseases and Treatments
ResumoThe author reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The author reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. There is a confectionery with 2 candy bars contained in a single package. The video advertisement for this product humorously implies that the “left” bar is manufactured in the “left bar factory” separately from the “right” bar, and the manufacturing secrets are jealously guarded from each other. It is obvious that the 2 bars are the same, which is the basis for the ridiculousness. So too is the left internal mammary artery (LIMA) the same as the right internal mammary artery (RIMA). The RIMA releases the same vasoactive substances, has the same composition, and reacts to stimuli the same as the LIMA. If either were used as an in situ graft to the same target, there would is no reason to suspect their fates would differ. Given that the LIMA is such a good conduit and no different than the RIMA, why do we not use the RIMA more often as an additional arterial conduit? The argument might be that the target vessel or the patient is unworthy of such a good conduit, or that it cannot reach the target, or that it would induce mediastinal infection in excess of the benefit provided by bilateral internal mammary artery (BIMA) use. Whatever the reason, we know that BIMA use is not widespread, and in 2014 was estimated to be 4.3% in North America.1Schwann T.A. Tatoulis J. Puskas J. Bonnell M. Taggart D. Kurlansky P. et al.Worldwide trends in multi-arterial coronary artery bypass grafting surgery 2004-2014: a tale of 2 continents.Semin Thorac Cardiovasc Surg. 2017; 29: 273-280Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Marzouk and colleagues2Marzouk M. Kalavrouziotis D. Grazioli V. Meneas C. Nader J. Simard S. et al.Long-term outcome of the in situ versus free internal thoracic artery as the second arterial graft.J Thorac Cardiovasc Surg. 2020; https://doi.org/10.1016/j.jtcvs.2020.03.003Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar compared BIMA coronary artery surgery outcomes when the RIMA was used as a free graft rather than as an in situ graft. In their commentary, Schwann and Gaudino3Schwann T.A. Gaudino M. Commentary: to BIMA or not to BIMA, that should be the question, rather than how to BIMA.J Thorac Cardiovasc Surg. 2020; https://doi.org/10.1016/j.jtcvs.2020.03.063Abstract Full Text Full Text PDF Scopus (4) Google Scholar implied that a more relevant question than how to use BIMA (ie, configuration) is whether to use BIMA. It is true that most cardiac surgeons are unwilling to use all-arterial or maximal-arterial grafting strategies in their coronary practices,1Schwann T.A. Tatoulis J. Puskas J. Bonnell M. Taggart D. Kurlansky P. et al.Worldwide trends in multi-arterial coronary artery bypass grafting surgery 2004-2014: a tale of 2 continents.Semin Thorac Cardiovasc Surg. 2017; 29: 273-280Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar and whether to use BIMA will remain a contentious issue. Who knows what's going on in that “right bar factory”! But how we use BIMA is indeed the question, as Kalavrouziotis and Mohammadi4Kalavrouziotis D. Mohammadi S. “How to BIMA” is in fact the question.J Thorac Cardiovasc Surg. 2021; 161: e31Abstract Full Text Full Text PDF Scopus (4) Google Scholar replied in their letter to the editor. With some criticism that we do not know the reason why free RIMA recipients fared worse than in situ RIMA recipients, Marzouk and colleagues2Marzouk M. Kalavrouziotis D. Grazioli V. Meneas C. Nader J. Simard S. et al.Long-term outcome of the in situ versus free internal thoracic artery as the second arterial graft.J Thorac Cardiovasc Surg. 2020; https://doi.org/10.1016/j.jtcvs.2020.03.003Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar showed that, whatever the reason, they fared differently. Thus, “how to BIMA” can be said to matter. Coronary artery surgery is a subspecialty in itself, and it is doubtful that any subspecialty coronary surgeon would consider not performing a second arterial graft to the lateral wall as the starting point for their revascularization strategy. In combination with the radial artery, BIMA is an integral part of this strategy. When only 2 arteries are used for the revascularization, a radial artery strategy may be associated with fewer complications5Schwann T.A. Habib R.H. Wallace A. Shahian D. Gaudino M. Kurlansky P. et al.Bilateral internal thoracic artery versus radial artery multi-arterial bypass grafting: a report from the STS database.Eur J Cardiothorac Surg. 2019; 56: 926-934Crossref PubMed Scopus (10) Google Scholar and greater ease of access. Deference to a radial artery over a RIMA may partly account for the lower use of BIMA strategies. Arterial graft configuration (eg, in situ composite arterial grafts, T grafts, aortoarterial grafts, sequential grafts) may also impact outcome. Becoming facile with extending in situ BIMA-based conduits to reach coronary targets opens the possibilities for maximal arterial grafting. It will be these outcomes, stratified by how arterial grafting is done, that will determine whether it should be done. “How to BIMA?” is in fact the questionThe Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 1PreviewWe read with interest the Commentary by Schwann and colleagues1 written in response to our original manuscript.2 We do not agree with the authors, who place the emphasis entirely on bilateral internal mammary artery (BIMA) use, and state that the configuration of BIMA grafts has no relevance. Although we are firm believers in the benefits of BIMA grafting, the optimal configuration of BIMA grafts still remains a matter of controversy. It was not our goal to compare BIMA versus single internal mammary artery grafting (SIMA), and 100% of patients in both comparator groups were BIMA recipients. Full-Text PDF
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