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Raja. Vessel Plus 2019;3:23 Vessel Plus
DOI: 10.20517/2574-1209.2019.05

Review Open Access

Total arterial coronary grafting: outcomes, concerns
and controversies

Shahzad G. Raja

Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK.
Correspondence to: Dr. Shahzad G. Raja, Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, Middlesex
UB9 6JH, UK. E-mail: drrajashahzad@hotmail.com

How to cite this article: Raja SG. Total arterial coronary grafting: outcomes, concerns and controversies. Vessel Plus 2019;3:23.
http://dx.doi.org/10.20517/2574-1209.2019.05

Received: 27 Mar 2019 First Decision: 22 Apr 2019 Revised: 11 Jun 2019 Accepted: 12 Jun 2019 Published: 11 Jul 2019
Science Editor: Mario F. L. Gaudino Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract

Choice of conduit remains the Achilles heel of coronary artery bypass grafting. Conduit choice is crucial as it is
Received: First Decision: Revised: Accepted: Published: x
deemed to influence the long-term outcomes. While the important survival advantage of a left internal mammary
Science Editor: Copy Editor: Production Editor: Jing Yu artery graft over vein grafts is universally accepted, controversy reigns supreme regarding the next best conduit.
There is plenty of evidence to suggest that arterial grafts are not only superior in terms of patency and survival,
but they also protect the native coronary arteries against further progression of atherosclerotic disease. Total
arterial coronary grafting, utilizing various configurations of bilateral internal mammary arteries, radial artery and
occasionally right gastroepiploic artery is a safe and reproducible strategy. However, concerns about additional
operative time, enhanced technical complexity, graft spasm with hypoperfusion, competitive flow, increased risk
of bleeding, deep sternal wound infection, and most importantly lack of randomized trial data have prevented the
universal adoption of total arterial coronary grafting. This review evaluates the currents outcomes of total arterial
coronary grafting and summarizes the concerns and controversies associated with this strategy.

Keywords: Coronary artery bypass grafting, bilateral internal mammary artery grafting, multiple arterial grafting,
total arterial grafting, total arterial revascularization

INTRODUCTION
Coronary artery bypass grafting (CABG) remains, more than five decades after its introduction into
clinical practice, the most scrutinized surgical procedure and a therapeutic intervention of paramount

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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