Conclusions
Recent studies have demonstrated superior performance of RA as second conduit for CABG34. Nevertheless, it remains unclear whether its patency rate is related to correct indications (e.g. critical coronary artery stenosis), less invasive and/or no-touch harvesting techniques or to the use of antispasmodic drugs.
There are some evidences that support the use CB to ameliorate RA patency24, however given the lack of large randomized trials on the specific topic (CCB versus no-CCB), final conclusions and recommendations cannot be drawn.
Importantly, the side effects of CB grafting are not negligible and should be taken into account in clinical decision-making.
Finally, understanding the triggers and mechanisms that regulate RA vessel tone and its response to endogenous and exogenous stimulation is pivotal in optimizing RA use as bypass conduit.