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© 2017, Indian Association of Cardiovascular-Thoracic Surgeons. This review focuses on the key issues raised during the International Coronary Congress (ICC) 2016. The left internal thoracic artery and the drug-eluting stents in relation to the left anterior descending artery re-vascularization have been compared and the role of Heart Team stressed upon. The current role of bilateral internal thoracic artery grafting is discussed. The importance of and tools for intra-operative assessment of graft patency have been outlined. The patency and related issues of saphenous vein grafts harvested using the no-touch technique has been discussed in detail. Following the discussion at ICC 2016 and review of literature, we conclude that left internal thoracic artery remains the best option for left anterior descending artery lesions and for left main and ostial or proximal left anterior descending artery lesions. The Heart Team should be approached for decision making. Bilateral internal thoracic artery usage should be encouraged especially in the Indian population which includes a higher proportion of younger patients with a particularly high prevalence of diabetes. Transit time flowmetry is a useful tool to confirm and assess whether intra-operative graft flow and saphenous vein grafts harvested with a no-touch technique have better patency than conventionally harvested vein grafts.

Original publication




Journal article


Indian Journal of Thoracic and Cardiovascular Surgery

Publication Date





44 - 52