Coronary artery bypass grafting (CABG) is an established therapy for obstructive cardiovascular disease and ischemic cardiomyopathy. Utilization of the left-internal mammary artery as a graft has been a particularly successful aspect of CABG due to impressively durable patency rates. Despite this, adoption of bilateral mammary artery grafting has lagged in surgical practice.\u00a0 The Arterial Revascularization Trial (ART) randomized a total of 3102 patients to either single or bilateral mammary grafting. At five years there were no differences between groups in the rates of death (8.7% vs. 8.4%; P=0.77) or major adverse cardiovascular events including myocardial infarction and stroke (12.2% vs. 12.7%; P=0.69).\u00a0\u00a0 Rates of sternal wound infections and sternal reconstruction were significantly higher in the bilateral mammary group (P=0.005) while rates of clinical angina were no different at 5 years.<\/p>\n
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Conclusions<\/p>\n
At 5 years there is no difference in clinical efficacy between bilateral and single internal mammary grafting in patients requiring CABG. Long-held concerns regarding immediate post-operative complications when utilizing both mammary arteries were validated. \u00a0Based on the modest durability of vein grafts, primary arterial conduits are hypothesized to hold the keys to even better CABG outcomes, but realizing these benefits remain elusive in practice.<\/p>\n
Taggart DP, Altman DG, Gray AM, Lees B, Gerry S, Benedetto U,\u00a0 and Flather M,\u00a0 for the ART Investigators.\u00a0 \u00a0Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery. N Engl J Med. 2016 Nov 14. [Epub ahead of print]<\/p>\n
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Husain Contractor and James M. McCabe<\/p>\n
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Coronary artery bypass grafting (CABG) is an established therapy for obstructive cardiovascular disease and ischemic cardiomyopathy. Utilization of the left-internal mammary artery as a graft has been a particularly successful aspect of CABG due to impressively durable patency rates. Despite this, adoption of bilateral mammary artery grafting has lagged in surgical practice.\u00a0 The Arterial Revascularization […]<\/p>\n