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Record W4309962672 · doi:10.1016/j.xjon.2022.11.008

Reply: The right internal mammary artery graft is a mirage

2022· article· en· W4309962672 on OpenAlexaff
André Lamy

Bibliographic record

VenueJTCVS Open · 2022
Typearticle
Languageen
FieldMedicine
TopicCardiac and Coronary Surgery Techniques
Canadian institutionsPopulation Health Research InstituteMcMaster University
Fundersnot available
KeywordsMammary arteryMedicineArteryVeinBypass graftingConflict of interestCardiologyInternal medicineSurgeryLawPolitical science

Abstract

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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. 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. First, we should not put total arterial and multiple arterial grafts in the same sentence and compare them with single arterial grafts but rather look at each graft individually. The conclusion of our manuscript1Alboom M. Browne A. Sheth T. Zheng Z. Dagenais F. Noiseux N. et al.Conduit selection and early graft failure in coronary artery bypass surgery: a post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study.J Thorac Cardiovasc Surg. June 2, 2022; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar is that the left internal mammary artery and radial artery performed as expected, whereas vein grafts performed better than expected. However, high rates of right internal mammary artery (RIMA) failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in coronary artery bypass grafting surgery. The RIMA graft has a greater rate of failure due to the harvesting by the skeletonization technique, and this has been demonstrated in Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS)2Lamy A. Eikelboom J. Sheth T. Connolly S. Bosch J. Fox K.A. et al.Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS CABG study.J Am Coll Cardiol. 2019; 73: 121-130Crossref PubMed Scopus (64) Google Scholar,3Lamy A. Browne A. Sheth T. Zheng Z. Dagenais F. Noiseux N. et al.Skeletonized vs pedicled internal mammary artery graft harvesting in coronary artery bypass surgery: a post hoc analysis from the COMPASS trial.JAMA Cardiol. 2021; 6: 1042-1049Crossref PubMed Scopus (24) Google Scholar and Arterial Revascularization Trial (ART).4Gaudino M. Audisio K. Rahouma M. Chadow D. Cancelli G. Soletti G.J. et al.ART InvestigatorsComparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the Arterial Revascularization Trial.JAMA Cardiol. 2021; 6: 1380-1386Crossref PubMed Scopus (23) Google Scholar Case closed. The in situ configuration (going behind the heart to the circumflex artery), in comparison with a Y graft coming from the left internal mammary artery, is associated with a lower patency in our manuscript but also with worse clinical outcomes in the reference provided by Prof Formica and his colleagues. They are correct saying this is a surgeon-related factor rather than a biological one. It is a technical problem, and we must fix it. The recent network analysis by Gaudino and colleagues5Gaudino M. Audisio K. Di Franco A. Alexander J.H. Kurlansky P. Boening A. et al.Radial artery versus saphenous vein versus right internal thoracic artery for coronary artery bypass grafting.Eur J Cardio Thorac Surg. 2022; 62: ezac345https://doi.org/10.1093/ejcts/ezac345Crossref PubMed Scopus (13) Google Scholar is compelling evidence that the right internal thoracic artery is not better than a vein and inferior to a radial artery. We must also keep in mind that vein grafts are better in recent trials than older trials, likely due to the use of cholesterol-reducing medication. While radial arteries have been tested in good trials, the best right internal thoracic artery configuration has not been demonstrated. There is an urgent need for a thorough evaluation of the patency and safety of the RIMA in coronary artery bypass grafting surgery, and surgeons should know their results and present them. It is an issue of intellectual integrity and patient safety. Multiple and total arterial grafts are not a mirage anymore!JTCVS OpenVol. 13PreviewThe use of single arterial graft (SAG) is the most used technique for coronary artery bypass grafting (CABG), although a body of literature reports an increasing use of multiple (MAG) and total arterial graft (TAG).1,2 Unfortunately, the use of MAG/TAG is still underused, being reported between 10% and 35% in Europe and North America.3 Factors such as higher consuming time, greater prone to spasm, and technical harvesting lead surgeons to prefer SAG to MAG/TAG (Figure 1). In addition, the latest guidelines encourage percutaneous coronary intervention in 3-vessel coronary artery disease patients with limited coronary calcification and favor the use of CABG in patients with extensive coronary calcifications. Full-Text PDF Open Access

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesInsufficient payload (model declined to judge)
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Empirical · Consensus signal: none
Teacher disagreement score0.654
Threshold uncertainty score0.997

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0010.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0010.001
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0040.000

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.

Opus teacher head0.015
GPT teacher head0.280
Teacher spread0.265 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designNot applicable
Domainnot available
GenreEmpirical

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".

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Citations0
Published2022
Admission routes1
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