Extended use of arterial conduits for myocardial revascularization

Myocardial revascularization by means of surgical coronary artery bypass grafting has proven to provide reproducible and durable relief from the sequellae of coronary atherosclerosis. Despite the proven success of this operation, efforts are ongoing both to reduce the perioperative risks and morbidity, as well as to improve the long-term outcomes. The use of multiple arterial conduits is an example of the latter. This is based on the proven superior long-term patency of arterial grafts as compared with venous conduits. A remarkable wide variety of conduits and configurations are being explored currently. We outline our current thinking with regard to arterial grafting as the field now stands. The early results are encouraging, and suggest a significant improvement in long-term relief from angina pectoris and freedom from reintervention when multiple arterial conduits are employed.