What is the optimal target for the second arterial graft in patients undergoing coronary bypass surgery?
Bibliographic record
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the anterolateral or the inferior wall served as a better location for the 2nd arterial graft in a 3-system coronary artery bypass grafting procedure. In total, more than 1800 papers were found, of which 6 represented the best evidence to answer the clinical question. All papers demonstrated equivalent early postoperative mortality and morbidity. The 3 largest studies comparing bilateral internal thoracic arteries showed no difference in perioperative mortality and morbidity regardless of whether the 2nd internal thoracic artery was used to graft the left or right system. One of these studies, however, showed significant survival benefit for the left-sided group at 8 years, whereas another study showed a reduced patency of right internal thoracic arteries when grafted to the right coronary artery and when used in situ. One study compared radial grafts to the right- and left-sided targets and showed no difference in long-term patency. Another study also reported on the angiographic patency of right internal thoracic arteries. The authors noted a non-significant increase in graft failure when non-left anterior descending arteries were grafted but no difference between circumflex or posterior descending arteries. All studies demonstrated similar or better mid- and long-term outcomes and patency rates when using the 2nd arterial graft to revascularize left-sided targets when compared with the right. However, all outcomes were similar when comparing non-left anterior descending left-sided targets with non-right coronary artery right-sided targets. Therefore, the right coronary artery itself should probably be avoided as the 2nd arterial target.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.005 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".