Response to Letters Regarding Article, “Second Internal Thoracic Artery Versus Radial Artery in Coronary Artery Bypass Grafting: A Long-Term, Propensity Score-Matched Follow-Up Study”

We thank Drs Ahmed and Edelman for their interest in our article.1 They expressed concerns about a possible bias toward radial artery (RA) use in comparison with right internal thoracic artery (RITA), because more than two thirds of multiple arterial revascularization (MAR) cases have a RA as a second arterial conduit. The proportion of RA and RITA patients directly reflects the current epidemiological distribution of RA and RITA grafts used. In the United States, the RA is used more than twice as frequently as a RITA graft.2 When applying the inclusion criteria of our study, our institutional MAR rate has been 35% during the past 9 years, reflecting high experience with MAR on a daily routine basis. Only 4 surgeons performed MAR during the whole study period, …