Strategies for increasing adoption of multiarterial coronary bypass grafting

PURPOSE OF REVIEW: Recent studies have demonstrated a survival benefit in patients receiving multiarterial rather than single-arterial coronary artery bypass grafting; however, it remains underutilized and is only implemented in a minority of patients in North America. We aim to review contemporary data on the survival benefit for multiarterial bypass grafting as well as the support for various grafting strategies and conduit options to increase multiarterial grafting utilization. RECENT FINDINGS: While randomized data is lacking, national database and cohort studies have observed improved survival in nearly all patient populations receiving multiarterial grafting compared to single-arterial grafting. Despite this multiarterial grafting is used in only 15% of isolated coronary bypass graftings in the United States. Several studies have demonstrated the effectiveness of different conduit options and operative strategies to increase arterial conduit utilization. These include the addition of a radial artery graft, bilateral internal thoracic artery grafting, and sequential and composite conduit grafting. SUMMARY: There is a well described late survival benefit for multiarterial bypass grafting over single arterial grafting. Recent studies support a variety of conduit choices and operative strategies to increase multiarterial bypass grafting in a safe, stepwise fashion.