Abstract Introduction Despite advances in percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) remains the gold-standard therapy for patients with severe multivessel ischemic heart disease, providing superior prognostic and symptomatic benefits. The superiority of the left internal mammary artery (LIMA) over the saphenous vein graft (SVG) for left anterior descending artery revascularization is well established and considered standard of care. However, while total arterial revascularization (TAR) has been advocated as the optimal strategy for long-term graft patency and survival, its adoption remains limited. This systematic review aims to compare intraoperative parameters, short-term mortality, major adverse events, and long-term survival between TAR-CABG and conventional CABG. Methods This systematic review was conducted according to Cochrane methodology and PRISMA guidelines. A comprehensive search of PubMed, Embase, Web of Science, and Cochrane CENTRAL up to November 2025 was performed, including randomized controlled trials and observational studies comparing TAR-CABG with conventional CABG. Data extraction used predefined PICOS criteria and was organized in Microsoft Excel. Due to heterogeneity in study designs and outcomes, a quantitative meta-analysis was not performed, and findings were synthesized narratively. Results From 389 screened studies, fourteen studies including 6,133 patients undergoing TAR-CABG and 6,301 undergoing conventional CABG were included. Early outcomes were comparable between groups. Mean in-hospital mortality was 1.3% for TAR-CABG and 1.9% for conventional CABG. Mean cardiopulmonary bypass time was slightly shorter for TAR-CABG (76 vs 84 minutes), while mean aortic cross-clamp time was similar (48 vs 49 minutes). Postoperative ventilation averaged 14 hours for TAR-CABG and 16 hours for conventional CABG, and mean ICU stay was comparable (36 vs 37 hours). Rates of postoperative complications including atrial fibrillation, myocardial infarction, acute renal failure, and stroke were similar. A few studies reported long-term survival, suggesting a potential benefit for TAR-CABG, with lower all-cause mortality at 5-10 years compared with conventional CABG. Conclusion TAR-CABG demonstrates comparable short-term outcomes, including in-hospital mortality, operative times, ventilation, ICU stay, and complications, compared with conventional CABG. Although a few studies suggest a long-term survival benefit, current evidence is limited and heterogeneous. A comprehensive meta-analysis is warranted to provide a more robust comparison and guide optimal revascularization strategies. This abstract is funded by: None
Sadiq et al. (Fri,) studied this question.