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Comparative Estimation of Long-Term Graft Patency Rates After Isolated Coronary Artery Bypass Grafting: A Systematic
Tia Fredericks1, Nayeem Nasher1, Christopher D Pritting1
1From the Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA.
Cardiology in Review
|November 14, 2025
Summary
Left internal mammary artery (LIMA) offers the best long-term patency for coronary artery bypass grafting. Arterial grafts generally outperform vein grafts, with LIMA, right internal mammary artery (RIMA), radial artery (RA), and gastroepiploic artery (GEA) showing superior results.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Biomedical Engineering
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for ischemic heart disease.
- Graft patency is a key determinant of long-term CABG success.
- Understanding the comparative long-term performance of different graft conduits is essential for surgical decision-making.
Purpose of the Study:
- To systematically evaluate and compare the long-term patency rates of various arterial and venous grafts used in isolated CABG procedures.
- To provide evidence-based recommendations for conduit selection in CABG surgery.
Main Methods:
- A comprehensive literature search was conducted across multiple databases, identifying 139 studies involving 56,827 patients undergoing isolated CABG.
- Patency outcomes for different graft types, including left internal mammary artery (LIMA), right internal mammary artery (RIMA), gastroepiploic artery (GEA), radial artery (RA), and saphenous vein graft (SVG), were analyzed.
- Parametric extrapolation was employed to estimate long-term (20-year) patency rates based on mean patency and follow-up duration.
Main Results:
- The left internal mammary artery (LIMA) exhibited the highest mean patency (96%) at a mean follow-up of 3.2 years.
- Other arterial grafts showed substantial patency: RIMA (94% at 2.8 years), GEA (93% at 1.7 years), and RA (89% at 3.7 years).
- Saphenous vein grafts (SVGs) had the lowest mean patency (82% at 3.5 years). Extrapolated 20-year patency rates favored arterial grafts, with LIMA at 77% and SVG at 33%.
Conclusions:
- Arterial conduits, particularly LIMA, demonstrate significantly superior long-term patency compared to venous grafts in CABG surgery.
- LIMA is the preferred conduit, with RIMA, RA, and GEA serving as valuable secondary arterial options based on patient-specific factors.
- Vein grafts, while still utilized, show the poorest long-term patency and should be considered with caution.
