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Raja. Vessel Plus 2019;3:23 I http://dx.doi.org/10.20517/2574-1209.2019.05 Page 9 of 11

Table 2. Key studies comparing impact of three arterial grafts versus two arterial grafts on long-term survival
PSM Numbers Follow-up
Author Year Study type Improved survival
2-Art 3-Art Duration (months)
Benedetto et al. [41] 2016 PSM 275 275 2-Art = 126 ± 58.8 3-Art = 126 ± 54 No
Di Mauro et al. [43] 2008 PSM 590 295 2-Art = 88 No^
3-Art = 128
Glineur [44] 2013 PSM 203 93 2-Art = 196.8 ± 74.4 Yes
3-Art = 192 ± 64.8
Grau et al. [45] 2015 PSM 183 183 NR (max 14 y) Yes
Locker et al. [46] 2012 PSM NR NR Mean: 91.2 ± 55.2 Yes
1029* 155* Median: 87.6
Mohammadi et al. [47] 2016 PSM 249 249 2-Art = 97.8 (IQR, 0.03-22.6) No
3-Art = 97.2 (IQR, 0.02-17)
Nasso et al. [48] 2012 PSM 3584 3584 Mean: 37.2 No
Shi et al. [49] 2016 PSM 262 262 2-Art = 144 ± 60 Yes
3-Art = 144 ± 60
Luthra et al. [50] 2018 PSM 167 167 Max: 7 y No
Formica et al. [51] 2019 PSM 190 190 Max: 18.5 y (IQR, 5.6-13) No

*Non-propensity matched cohort; ^Increased mortality and cardiac death with addition of third arterial conduit (gastroepiploic artery)
Abbreviations: 2-Art: 2 arterial grafts; 3-Art: 3 arterial grafts; IQR: interquartile range; NR: not reported; PSM: propensity score matched

CONCLUSION
TAR, with its well-recognized benefits of enhanced long-term survival and freedom from re-intervention
and cardiac events, is an attractive revascularization option for patients with multi-vessel coronary artery
disease. However, the universal adoption remains extremely low due to lack of evidence from RCTs,
relatively greater technical complexity and length of the procedure, the perceived increased risk of DSWI
and other complications, and the prolonged interval before survival benefits are derived from this strategy.
If TAR is to gain popularity then compelling data from RCTs is the single most important strategy to
improve uptake of this technique.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article

Availability of data and materials
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Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
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Copyright
© The Author(s) 2019.