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This letter was referred to Dr. Korkmaz, who replies in this manner:
When the 4 patients with nonsignificant lesions (20%–25% stenosis) were inspected during the operation, their lesions were seen to be yellowish, soft plaque with partial thrombus, which we judged to be prone to rupture and embolization. To eliminate the occlusion risk, we performed CCBG with a segment of ITA. Although CCBG was performed on vessels with nonsignificant stenosis, the postoperative angiograms revealed patent grafts.
Bruschke and colleagues1 state that RCA atherosclerosis progresses chiefly in the first segment of the RCA and in the mid-RCA. Our experience supports this view. Therefore, when performing the proximal CCBG anastomosis in the atherosclerotic RCA, the surgeon should first choose the ostium (if it is free of calcification), and then make the distal anastomosis beyond the crux of the RCA. By performing the proximal anastomosis in the ostium, one can avoid the risk of atherosclerotic progression in the proximal RCA. If the patient has less extensive atherosclerosis in the RCA and the first segment is seen to be free of lesions, upon angiographic and intraoperative inspection, then CCBG anastomosis can be performed in any segment of the RCA. The distal RCA anastomosis site is also very important for long-term patency, which is why our preferred site is beyond the crux.
We thank Dr. Nezic and his colleagues for their keen attention. In our calculations, all our data were based on weeks, but in the text the mean duration of angiographic follow-up was mistyped as 16.5 months. We sincerely apologize for this mistake and agree with the correction.