[The state of the art for arterial coronary artery bypass grafting]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The choice of graft conduit is a critical, debated aspect of coronary artery bypass grafting (CABG).
• Arterial grafts are recognized for superior biological properties and long-term patency compared to traditional venous grafts.
• The internal thoracic artery is established as the gold standard graft in CABG based on extensive clinical evidence.

Purpose of the Study:

• To review the evidence supporting arterial grafts in CABG.
• To discuss the benefits and challenges of multi-arterial and total-arterial CABG.
• To advocate for the increased application of arterial CABG in China.

Main Methods:

• Review of clinical observations and randomized clinical trials over two decades.
• Analysis of published guidelines and expert consensus statements.
• Evaluation of trends in coronary surgery and graft selection.

Main Results:

• Multi-arterial and total-arterial CABG significantly enhance long-term patient survival.
• The internal thoracic artery demonstrates excellent long-term patency and biological characteristics.
• Despite technical challenges and concerns of sternal complications, arterial grafting is increasingly favored globally.

Conclusions:

• Arterial coronary artery bypass grafting offers superior long-term outcomes and should be more widely implemented.
• The accumulation of evidence and excellent long-term clinical results support broader application of arterial CABG in China.
• Continued quality improvement in coronary surgery in China necessitates wider adoption of arterial grafting techniques.