It is well known that the left internal mammary artery (LIMA) should be
the first conduit of choice. Similarly, especially in patients younger
than 70 years, other conduits should be search among arterial grafts
such as right internal mammary artery (RIMA) or radial artery (RA). If
the RA can be harvested in the meanwhile of LIMA harvesting without time
consuming, it is well established that former one has to be grafted only
on presence of a good run-off. One of the main criticisms moved to the
use of RIMA are linked to technical difficulties in its harvesting it.
Edgar Aranda-Michel and coworkers tried to answer to the age-old
question is “RIMA has to be used in situ or free-graft?” In a
retrospective study on 667 patients (442 had free RIMA and 245 had free
RIMA) that were also matched through propensity analysis (202 patients
per group), they did not find any differences between the two groups in
the major outcomes, including heart failure specific readmissions. This
finding is consistent with the literature, hence the take-home message
is whatever happens, two mammary is better than one.