Why do UK cardiac surgeons not perform their first choice operation for coronary artery bypass graft?

For the past 15 years the “standard” coronary artery bypass graft (CABG) operation for multi-vessel coronary artery disease has used the left internal mammary artery and supplemental saphenous vein segments for conduits.1 However, increasing evidence suggests that arterial conduits have superior patency rates to vein grafts2 leading to improved survival and reduced need for reintervention.3,4 It is therefore surprising that the uptake of multiple arterial grafts for CABG remains poor. Of 23 000 first time isolated multi-vessel CABG procedures reported in the 1999-2000 database of the Society of Cardiothoracic Surgeons of the United Kingdom and Ireland (SCTS), around 3600 (little over 15%) used more than one arterial graft. We conducted a postal survey of UK consultant cardiac surgeons to identify what factors contributed to the relatively low proportion of patients receiving multiple arterial grafts. Consultant cardiac surgeons with a predominantly adult practice were identified from the registry of the SCTS. An anonymous postal survey of 142 consultants was carried out in two mailings. A series of questions with fixed possible responses were asked in a brief format. The specific questions and response options are detailed in questions 1–4 and the corresponding figures below. Question 1 Is there any evidence to show an advantage of using multiple …