Based on acute outcomes, "all arterial" coronary bypass surgery should be performed on younger elective patients

This study evaluated acute results as a function of the number of arterial conduits used to compare procedural differences and the subsequent effects on acute outcomes in selected patient populations.

All arterial operations may provide better long-term results for younger patients undergoing coronary bypass surgery (CABG). However, concerns regarding additional morbidity when using multiple arterial conduits have inhibited their use.

The study comprised a retrospective review of patients (2,586) undergoing CABG. Group 1 consists of single artery vein graft (1,755). Group 2: two arteries were used in addition to vein grafts (209). Group 3: three or more arterial conduits were used, with or without vein grafts (116). Group 4: only vein grafts were used (506).

Patients undergoing primarily arterial procedures, Group 2 and 3, were younger, had a better exercise profile, less history of myocardial infarction (MI), had less left ventricular dysfunction. There were also fewer emergencies, co-morbidities and associated procedures in this group. The cardiopulmonary bypass and cross clamp times were longer in those procedures with three or more arteries; however, this difference was only thirteen and fourteen minutes, respectively. Post-operative complications were higher in patients in the vein only group. The hospital stay and mortality was equivalent among groups in which an arterial bypass was used and better than those in which only vein grafts were used.

For younger patients, "all arterial operations," require only minimal increases in ischemic and operative times, which do not affect acute outcomes.