Multiple Arterial Grafts for CABG Surgery Offer Significant Benefits

Kathleen Petro, MD is a board certified Thoracic and Cardiac Surgeon with Inova Heart and Vascular Institute.

Over the last several years, Inova’s cardiac surgery team has focused its efforts on improving outcomes for patients undergoing Coronary Artery Bypass Graft (CABG) surgery through the use of multiple arterial grafts. Currently, more than 60% of our patients receive two or more arterial grafts without an increase in surgical complications.

For more than two decades, it has been generally accepted that patients who receive multiple arterial grafts at the time of CABG have better long-term survival rates as compared with those who receive only one arterial graft. U.S. and European guidelines strongly recommend the use of multiple arterial grafts in patients with long life expectancies.

Unfortunately, adoption of these guidelines in the U.S. has been slow and according to the Society of Thoracic Surgeons (STS), only about 12% of CABG patients receive a second arterial graft. This increases to approximately 20% for young (under 50), low-risk patients, but even that number has remained low and has remained unchanged over the last 10 years.

There are several reasons explaining the slow adoption by the surgical community. These include concerns about postoperative complications such as poor  healing of the breast bone and competitive graft flow, as well as the fact that the procedure is technically more challenging, it’s very time consuming and many surgeons have not been trained in the technique. 

Inova’s cardiac surgery program has achieved and maintained the highest rating from STS for CABG surgery every year since 2016. Notably, the 3-star rating for isolated CABG includes top ratings across all the categories, a result achieved by a limited number of programs nationally.

Not every patient is a candidate for the use of multiple arterial conduits. However, in terms of outcomes, the currently available evidence is compelling, with the majority of benefits seen in patients with multivessel disease, followed by those with left main vessel disease. Inova’s cardiac surgery team is committed to making the procedure an integral part of our strategy to restore blood flow in blocked vessels.