From risk to results: Multi-arterial coronary bypass approaches in high-risk cohorts

Over the past 30 years, multi-arterial coronary artery bypass grafting techniques have been shown to be associated with improved patient outcomes compared to the current standard, single-arterial coronary bypass grafting technique, in the general patient population undergoing surgical coronary revascularization. Whether a survival benefit exists in high-risk patient sub-cohorts is less well defined, calling into question the value of the higher technical complexity of multi-arterial bypass grafting. Herein, we review the most current evidence for multi-arterial bypass grafting versus single arterial bypass grafting in several higher-risk patient cohorts. Discussion will focus on the two most common techniques for multi-arterial bypass grafting: the use of bilateral internal thoracic arteries and the use of the left internal thoracic artery in conjunction with the radial artery with or without supplemental saphenous vein grafts.