Left-right choice in coronary artery bypass grafting surgery

We thank Dr Karangelis for his comments on our recent article.1 We agree that the left coronary system represents the first target for bilateral internal thoracic artery (BITA) grafts, and that the role of BITA grafting for right coronary artery revascularization is less relevant.2 The BITA graft should be used for the right coronary artery when no targets suitable for the BITA graft are present on the left coronary artery system. As suggested by other reports,2 BITA grafts to the right coronary artery should be used only in the presence of severe proximal stenosis and viable myocardium in its distribution (good runoff). In the case of BITA grafting to the left coronary system, the radial artery remains a valid alternative for right coronary artery revascularization, particularly in young patients with long life expectancy.3