Two‐Conduit Total Arterial Revascularization: Sustained Expansion Despite Divergent CABG Outcomes Across the COVID‐19 Timeline

Background The COVID‐19 pandemic caused prolonged disruption in cardiac surgical care. It was unclear how coronary artery bypass grafting (CABG) outcomes evolved across the full COVID‐19 timeline and whether arterial grafting practices, specifically a simplified two‐conduit total arterial revascularization (TAR) strategy, were affected. This study describes temporal variation in CABG mortality, conduit patterns, and limb‐harvest complications across the COVID‐19 timeline. Methods A retrospective cohort of 564 consecutive patients undergoing isolated CABG between 2019 and 2024 was analyzed. Patients were stratified into four temporal periods: PRE‐COVID (2019–Feb 2020), COVID (Feb 2020–Apr 2022), POST‐COVID (Apr 2022–Dec 2023), and LATE POST‐COVID (2024). The primary outcome was in‐hospital and 30‐day mortality. Secondary outcomes included conduit utilization, radial artery (RA) adoption, TAR rates, and limb‐harvest infections. Results Mortality differed significantly across periods: PRE‐COVID 0.8%, COVID 3.8%, POST‐COVID 8.0%, and LATE POST‐COVID 1.8% ( p < 0.01). Mortality remained elevated for nearly 2 years and normalized only in 2024. RA use increased from 61.2% to 93.6% ( p < 0.001), saphenous vein use declined from 64.5% to 19.1% ( p < 0.001), and TAR rose from 35.5% to 80.9% ( p < 0.001). All TAR procedures were performed exclusively with two arterial conduits. Limb‐harvest infection decreased from 7.4% to 0.9% ( p = 0.025). Conclusions Across the COVID‐19 timeline, CABG outcomes and conduit strategies followed divergent trajectories: mortality increased transiently and normalized only in 2024, whereas TAR expanded steadily through a simplified two‐conduit approach. The reduction in limb‐harvest infection paralleled the decline in saphenous vein use rather than reflecting intrinsic superiority of the two‐conduit strategy itself. These findings describe institutional practice evolution during prolonged system disruption and do not imply a causal relationship between the pandemic and conduit selection.