Clinical application and strategy of total-arterial coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Jiawei ¹ , ZHANG Heng ^1,2 ,  ZHENG Zhe ^1,2

1. National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Beijing, 100037, P. R. China;
2. Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Coronary artery bypass grafting; total arterial grafts; internal mammary artery; review

DOI：

10.7507/1007-4848.202302070

Video：

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Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.

Citation： HAN Jiawei, ZHANG Heng, ZHENG Zhe. Clinical application and strategy of total-arterial coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 304-310. doi: 10.7507/1007-4848.202302070 Copy

1.	Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
2.	Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: A meta-analysis approach. Circulation, 2014, 130(7): 539-545.
3.	Gaudino M, Bakaeen FG, Benedetto U, et al. Arterial grafts for coronary bypass: A critical review after the publication of ART and RADIAL. Circulation, 2019, 140(15): 1273-1284.
4.	Schwann TA, Tatoulis J, Puskas J, et al. Worldwide trends in multi-arterial coronary artery bypass grafting surgery 2004-2014: A tale of 2 continents. Semin Thorac Cardiovasc Surg, 2017, 29(3): 273-280.
5.	Dalén M, Ivert T, Holzmann MJ, et al. Bilateral versus single internal mammary coronary artery bypass grafting in Sweden from 1997-2008. PLoS One, 2014, 9(1): e86929.
6.	Saran N, Locker C, Said SM, et al. Current trends in bilateral internal thoracic artery use for coronary revascularization: Extending benefit to high-risk patients. J Thorac Cardiovasc Surg, 2018, 155(6): 2331-2343.
7.	Goldstone AB, Chiu P, Baiocchi M, et al. Second arterial versus venous conduits for multivessel coronary artery bypass surgery in california. Circulation, 2018, 137(16): 1698-707.
8.	国家心血管病医疗质量控制中心. 《2021年中国心血管病医疗质量报告》概要. 中国循环杂志, 2021, 36(11): 1041-1064.
9.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
10.	Aldea GS, Bakaeen FG, Pal J, et al. The Society of Thoracic Surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting. Ann Thorac Surg, 2016, 101(2): 801-809.
11.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
12.	Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 145(3): e4-e17.
13.	Muneretto C, Bisleri G, Negri A, et al. Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: A prospective randomized comparison with conventional coronary artery bypass surgery. Circulation, 2003, 108 Suppl 1: Ⅱ29-Ⅱ33.
14.	Damgaard S, Wetterslev J, Lund JT, et al. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial. Eur Heart J, 2009, 30(8): 1005-1011.
15.	Taggart DP, Altman DG, Gray AM, et al. Randomized trial of bilateral versus single internal-thoracic-artery grafts. N Engl J Med, 2016, 375(26): 2540-2549.
16.	Taggart DP, Benedetto U, Gerry S, et al. Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med, 2019, 380(5): 437-446.
17.	Taggart DP, Altman DG, Flather M, et al. Associations between adding a radial artery graft to single and bilateral internal thoracic artery grafts and outcomes: Insights from the arterial revascularization trial. Circulation, 2017, 136(5): 454-463.
18.	Royse AG, Brennan AP, Ou-Young J, et al. 21-year survival of left internal mammary artery-radial artery-Y graft. J Am Coll Cardiol, 2018, 72(12): 1332-1340.
19.	Rocha RV, Tam DY, Karkhanis R, et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization. JAMA Cardiol, 2020, 5(5): 507-514.
20.	Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
21.	Gaudino M, Alexander JH, Bakaeen FG, et al. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: The ROMA trial-rationale and study protocol. Eur J Cardiothorac Surg, 2017, 52(6): 1031-1040.
22.	Buttar SN, Yan TD, Taggart DP, et al. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: A meta-analysis. Heart, 2017, 103(18): 1419-1426.
23.	Dai C, Lu Z, Zhu H, et al. Bilateral internal mammary artery grafting and risk of sternal wound infection: Evidence from observational studies. Ann Thorac Surg, 2013, 95(6): 1938-1945.
24.	Gaudino M, Taggart D, Suma H, et al. The choice of conduits in coronary artery bypass surgery. J Am Coll Cardiol, 2015, 66(15): 1729-1737.
25.	Zhou P, Zhu P, Nie Z, et al. Is the era of bilateral internal thoracic artery grafting coming for diabetic patients? An updated meta-analysis. J Thorac Cardiovasc Surg, 2019, 158(6): 1559-1570.
26.	Biancari F, Gatti G, Rosato S, et al. Preoperative risk stratification of deep sternal wound infection after coronary surgery. Infect Control Hosp Epidemiol, 2020, 41(4): 444-451.
27.	Gaudino M, Rahouma M, Abouarab A, et al. Radial artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A meta-analysis. J Thorac Cardiovasc Surg, 2019, 157(5): 1819-1825.
28.	Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: Results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol, 2012, 60(1): 28-35.
29.	Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med, 2018, 378(22): 2069-2077.
30.	Schwann TA, Habib RH, Wallace A, et al. Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting. Ann Thorac Surg, 2018, 105(4): 1109-1119.
31.	Buxton BF, Hayward PA, Raman J, et al. Long-term results of the RAPCO trials. Circulation, 2020, 142(14): 1330-1338.
32.	Pym J, Brown PM, Charrette EJ, et al. Gastroepiploic-coronary anastomosis. A viable alternative bypass graft. J Thorac Cardiovasc Surg, 1987, 94(2): 256-259.
33.	Suma H, Tanabe H, Takahashi A, et al. Twenty years experience with the gastroepiploic artery graft for CABG. Circulation, 2007, 116(11 Suppl): I188-I191.
34.	Suzuki T, Asai T, Nota H, et al. Early and long-term patency of in situ skeletonized gastroepiploic artery after off-pump coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 90-95.
35.	Di Mauro M, Contini M, Iacò AL, et al. Bilateral internal thoracic artery on the left side: A propensity score-matched study of impact of the third conduit on the right side. J Thorac Cardiovasc Surg, 2009, 137(4): 869-874.
36.	Hwang HY, Cho KR, Kim KB. Equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts: Five-year outcomes. Ann Thorac Surg, 2013, 96(6): 2061-2068.
37.	赵强, 刘俊, 叶晓峰, 等. 全动脉化冠状动脉旁路移植术的手术策略及临床结果. 中华外科杂志, 2020, 58(5): 356-362.
38.	Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: The forgotten conduit—5, 766 patients and 991 angiograms. Ann Thorac Surg, 2011, 92(1): 9-15.
39.	Liu DX, Chen XJ, Zheng BS, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: A multi-center retrospective study. Zhonghua Yi Xue Za Zhi, 2020, 100(18): 1390-1395.
40.	Raja SG. Surgical strategies for bilateral internal mammary artery grafting. Int J Surg, 2015, 16(Pt B): 140-145.
41.	Paterson HS, Naidoo R, Byth K, et al. Full myocardial revascularization with bilateral internal mammary artery Y grafts. Ann Cardiothorac Surg, 2013, 2(4): 444-452.
42.	Raja SG, Benedetto U, Husain M, et al. Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage? J Thorac Cardiovasc Surg, 2014, 148(4): 1275-1281.

1. Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
2. Yi G, Shine B, Rehman SM, et al. Effect of bilateral internal mammary artery grafts on long-term survival: A meta-analysis approach. Circulation, 2014, 130(7): 539-545.
3. Gaudino M, Bakaeen FG, Benedetto U, et al. Arterial grafts for coronary bypass: A critical review after the publication of ART and RADIAL. Circulation, 2019, 140(15): 1273-1284.
4. Schwann TA, Tatoulis J, Puskas J, et al. Worldwide trends in multi-arterial coronary artery bypass grafting surgery 2004-2014: A tale of 2 continents. Semin Thorac Cardiovasc Surg, 2017, 29(3): 273-280.
5. Dalén M, Ivert T, Holzmann MJ, et al. Bilateral versus single internal mammary coronary artery bypass grafting in Sweden from 1997-2008. PLoS One, 2014, 9(1): e86929.
6. Saran N, Locker C, Said SM, et al. Current trends in bilateral internal thoracic artery use for coronary revascularization: Extending benefit to high-risk patients. J Thorac Cardiovasc Surg, 2018, 155(6): 2331-2343.
7. Goldstone AB, Chiu P, Baiocchi M, et al. Second arterial versus venous conduits for multivessel coronary artery bypass surgery in california. Circulation, 2018, 137(16): 1698-707.
8. 国家心血管病医疗质量控制中心. 《2021年中国心血管病医疗质量报告》概要. 中国循环杂志, 2021, 36(11): 1041-1064.
9. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
10. Aldea GS, Bakaeen FG, Pal J, et al. The Society of Thoracic Surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting. Ann Thorac Surg, 2016, 101(2): 801-809.
11. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
12. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 145(3): e4-e17.
13. Muneretto C, Bisleri G, Negri A, et al. Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: A prospective randomized comparison with conventional coronary artery bypass surgery. Circulation, 2003, 108 Suppl 1: Ⅱ29-Ⅱ33.
14. Damgaard S, Wetterslev J, Lund JT, et al. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial. Eur Heart J, 2009, 30(8): 1005-1011.
15. Taggart DP, Altman DG, Gray AM, et al. Randomized trial of bilateral versus single internal-thoracic-artery grafts. N Engl J Med, 2016, 375(26): 2540-2549.
16. Taggart DP, Benedetto U, Gerry S, et al. Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med, 2019, 380(5): 437-446.
17. Taggart DP, Altman DG, Flather M, et al. Associations between adding a radial artery graft to single and bilateral internal thoracic artery grafts and outcomes: Insights from the arterial revascularization trial. Circulation, 2017, 136(5): 454-463.
18. Royse AG, Brennan AP, Ou-Young J, et al. 21-year survival of left internal mammary artery-radial artery-Y graft. J Am Coll Cardiol, 2018, 72(12): 1332-1340.
19. Rocha RV, Tam DY, Karkhanis R, et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization. JAMA Cardiol, 2020, 5(5): 507-514.
20. Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
21. Gaudino M, Alexander JH, Bakaeen FG, et al. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: The ROMA trial-rationale and study protocol. Eur J Cardiothorac Surg, 2017, 52(6): 1031-1040.
22. Buttar SN, Yan TD, Taggart DP, et al. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: A meta-analysis. Heart, 2017, 103(18): 1419-1426.
23. Dai C, Lu Z, Zhu H, et al. Bilateral internal mammary artery grafting and risk of sternal wound infection: Evidence from observational studies. Ann Thorac Surg, 2013, 95(6): 1938-1945.
24. Gaudino M, Taggart D, Suma H, et al. The choice of conduits in coronary artery bypass surgery. J Am Coll Cardiol, 2015, 66(15): 1729-1737.
25. Zhou P, Zhu P, Nie Z, et al. Is the era of bilateral internal thoracic artery grafting coming for diabetic patients? An updated meta-analysis. J Thorac Cardiovasc Surg, 2019, 158(6): 1559-1570.
26. Biancari F, Gatti G, Rosato S, et al. Preoperative risk stratification of deep sternal wound infection after coronary surgery. Infect Control Hosp Epidemiol, 2020, 41(4): 444-451.
27. Gaudino M, Rahouma M, Abouarab A, et al. Radial artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A meta-analysis. J Thorac Cardiovasc Surg, 2019, 157(5): 1819-1825.
28. Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: Results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol, 2012, 60(1): 28-35.
29. Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med, 2018, 378(22): 2069-2077.
30. Schwann TA, Habib RH, Wallace A, et al. Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting. Ann Thorac Surg, 2018, 105(4): 1109-1119.
31. Buxton BF, Hayward PA, Raman J, et al. Long-term results of the RAPCO trials. Circulation, 2020, 142(14): 1330-1338.
32. Pym J, Brown PM, Charrette EJ, et al. Gastroepiploic-coronary anastomosis. A viable alternative bypass graft. J Thorac Cardiovasc Surg, 1987, 94(2): 256-259.
33. Suma H, Tanabe H, Takahashi A, et al. Twenty years experience with the gastroepiploic artery graft for CABG. Circulation, 2007, 116(11 Suppl): I188-I191.
34. Suzuki T, Asai T, Nota H, et al. Early and long-term patency of in situ skeletonized gastroepiploic artery after off-pump coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 90-95.
35. Di Mauro M, Contini M, Iacò AL, et al. Bilateral internal thoracic artery on the left side: A propensity score-matched study of impact of the third conduit on the right side. J Thorac Cardiovasc Surg, 2009, 137(4): 869-874.
36. Hwang HY, Cho KR, Kim KB. Equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts: Five-year outcomes. Ann Thorac Surg, 2013, 96(6): 2061-2068.
37. 赵强, 刘俊, 叶晓峰, 等. 全动脉化冠状动脉旁路移植术的手术策略及临床结果. 中华外科杂志, 2020, 58(5): 356-362.
38. Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: The forgotten conduit—5, 766 patients and 991 angiograms. Ann Thorac Surg, 2011, 92(1): 9-15.
39. Liu DX, Chen XJ, Zheng BS, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: A multi-center retrospective study. Zhonghua Yi Xue Za Zhi, 2020, 100(18): 1390-1395.
40. Raja SG. Surgical strategies for bilateral internal mammary artery grafting. Int J Surg, 2015, 16(Pt B): 140-145.
41. Paterson HS, Naidoo R, Byth K, et al. Full myocardial revascularization with bilateral internal mammary artery Y grafts. Ann Cardiothorac Surg, 2013, 2(4): 444-452.
42. Raja SG, Benedetto U, Husain M, et al. Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage? J Thorac Cardiovasc Surg, 2014, 148(4): 1275-1281.

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