Key result
Extensive arterial revascularization using multiple arterial grafts provides superior long-term patency and prognosis compared to saphenous vein grafts in patients with multivessel coronary artery disease.
Why the study?
Does the use of multiple arterial grafts improve long-term patency and survival in patients with multivessel coronary artery disease compared to single arterial grafts with saphenous vein grafts?
Does the use of multiple arterial grafts improve long-term patency and survival in patients with multivessel coronary artery disease compared to single arterial grafts with saphenous vein grafts?
Extensive arterial revascularization in CABG offers superior long-term patency and survival compared to traditional LIMA-SVG grafting, though careful patient selection is required to minimize sternal wound complications.
May support multiple arterial grafts including RITA in CABG; leaves open confirmation by randomized trials.
It is well known that graft patency determines prognosis in coronary artery bypass grafting. Numerous reports over the past 20 years have documented superior patency and prognosis when multiple arterial grafts are used. The use of the left internal thoracic artery to graft the left anterior descending artery has been widely accepted as the gold standard for surgical treatment of coronary disease for over 40 years. A considerable body of evidence suggests that the right internal thoracic artery behaves in the same way. Radial artery grafts are being studied in several randomized trials, but observational studies suggest a performance comparing favorably with the saphenous vein. The right gastroepiploic artery has been recognized as a suitable and reliable conduit for coronary bypass surgery. However, the use of multiple other arterial grafts is performed in less than 10% of surgical procedures, probably because of perceptions of technical complexity, prolonged time for conduit harvesting, and increased perioperative complications. As a result, most patients with multivessel coronary artery disease do not benefit from extensive revascularization with arterial conduits. The aim of this review is to summarize the current evidence for the extensive use of arterial conduits in the revascularization of multivessel coronary artery disease.
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Nicolini et al. (2014) conducted a review in Multivessel Coronary Artery Disease. Multiple arterial grafts (BIMA, RA, GEA) vs. Single arterial graft with saphenous vein grafts was evaluated. Extensive arterial revascularization using multiple arterial grafts provides superior long-term patency and prognosis compared to saphenous vein grafts in patients with multivessel coronary artery disease.
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