What has happened to multiple arterial grafting in coronary artery bypass grafting surgery?
Coronary artery bypass grafting (CABG) is a well-established therapy for patients with multivessel coronary artery disease, with excellent short- and medium-term results. This is best illustrated by studies comparing percutaneous coronary interventions (PCIs) with CABG surgery, where CABG continues to offer better event-free survival. However, there has been increasing concern about the long-term patency of vein grafts utilized for CABG when compared with arterial grafts. Some have suggested that revascularization with arterial grafts rather than vein grafts may result in improved outcomes following CABG. This is particularly important when one considers that graft occlusion can result in recurrence of disabling angina, rehospitalization, reintervention and death. To date, however, multiple arterial grafts have yet to become the standard approach for patients undergoing CABG. This is best exemplified by reports from large registries suggesting that the use of multiple arterial grafting is limited to approximately 10% of all patients undergoing CABG. In this article, we will provide some of the evidence outlining the risk and benefits of multiple arterial grafting, but more importantly, begin to explore why the utilization of multiple arterial grafting does not appear to be increasing significantly.
Elghobary
Tamer
T
Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Légaré
Jean-Francois
JF
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D012501:Saphenous Vein / Q000637:transplantation; D014654:Vascular Patency