title: Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART).
abstract: OBJECTIVE
  Observational data suggest that the use of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery provides superior revascularization to a single internal mammary artery (SIMA), but concerns about safety have prevented the widespread use of BIMA. The Arterial Revascularisation Trial (ART) is a randomized trial of BIMA vs. SIMA, with a primary outcome of survival at 10 years. This paper reports mortality, morbidity, and resource use data at 1 year.
  
  
  RESULTS
  Coronary artery bypass graft patients were enrolled in 28 hospitals in seven countries. Three thousand one hundred and two patients were randomly assigned to SIMA (n = 1554) or BIMA (n = 1548). The mean number of grafts was 3 for both groups. Forty per cent of the SIMA procedures and 42% of the BIMA were performed off-pump. Mortality at 30 days was 18 of 1548 (1.2%) for SIMA and 19 of 1537 (1.2%) for BIMA, and at 1 year was 36 of 1540 (2.3%) and 38 of 1529 (2.5%), respectively. The rates of stroke, myocardial infarction, and repeat revascularization were all ≤2% at 1 year and similar between the two groups. Sternal wound reconstruction was required in 0.6 and 1.9% of the SIMA and BIMA groups, respectively.
  
  
  CONCLUSIONS
  Data from ART demonstrate similar clinical outcomes for SIMA and BIMA at 1 year but BIMA grafts are associated with a small absolute increase (1.3%) in the need for sternal wound reconstruction. The results suggest that the use of BIMA grafts is feasible on a routine basis. The 10-year results of the ART will confirm whether BIMA grafting results in lower mortality and the need for repeat intervention.
  
  
  BACKGROUND
  Controlled-trials.com (ISRCTN46552265).
authors.affiliation: Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK. david.taggart@orh.nhs.uk
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Altman
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Gray
authors.forename: Belinda
authors.initials: B
authors.lastname: Lees
authors.forename: Fiona
authors.initials: F
authors.lastname: Nugara
authors.forename: Ly-Mee
authors.initials: LM
authors.lastname: Yu
authors.forename: Helen
authors.initials: H
authors.lastname: Campbell
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
mesh_terms: D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome