Which Internal-Thoracic-Artery Graft Technique Is Optimal?

A randomized trial shows no advantage of bilateral over single grafts.

After decades of coronary artery bypass graft (CABG) surgery, questions about the optimal technique remain. Prior observational studies have suggested a survival benefit of bilateral (relative to single) internal-thoracic-artery grafting. In the multinational Arterial Revascularization Trial (ART), U.K.-based investigators randomized 3102 patients (mean age, 64; 86% men) with multivessel disease and no history of CABG to undergo either single or bilateral internal-thoracic-artery grafting. Participating surgeons had each previously conducted at least 50 operations with bilateral grafts.

At 5-year follow-up, the mortality rate was statistically similar in the two groups (bilateral graft, 8.7%; single graft, 8.4%), as was incidence of the comp…

Reviewing Author

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

Which Internal-Thoracic-Artery Graft Technique Is Optimal?

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Reviewing Author