title: Long-term results of multiple arterial bypass conduits.
abstract: OBJECTIVE
  Ongoing efforts to compare percutaneous coronary intervention with coronary bypass surgery for multivessel coronary disease mandate that surgeons reevaluate best practices for coronary surgery in order to maximize long-term outcomes. This review presents recent data for the long-term outcomes of multiple arterial grafting in terms of patient selection, conduit choice, and technical considerations.
  
  
  RESULTS
  Multiple arterial grafting remains poorly utilized, with fewer than 10% of cases receiving more than one arterial graft. Bilateral internal thoracic artery grafting confers superior long-term survival and freedom from reoperation over single thoracic artery with saphenous vein. Use of a second internal thoracic artery graft is advantageous in diabetic patients despite higher risk of sternal wound complications. Routine use of skeletonized grafts and Y or T grafting to allow complete revascularization allows lower early complication rates and better long-term survival. Radial artery grafts confer superior long-term survival compared with saphenous vein grafts and should be considered in patients at high risk for sternal wound complications.
  
  
  CONCLUSIONS
  Multiple arterial grafting confers superior long-term outcomes in comparison with single internal thoracic artery grafting and should be considered as the standard of care.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D014943:Global Health; D006801:Humans; D015994:Incidence; D008323:Mammary Arteries / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D017534:Radial Artery / Q000637:transplantation; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome