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Thorac Cardiovasc Surg
DOI: 10.1055/a-2700-7123
Original Cardiovascular

Is Total Arterial Grafting Superior to Multiarterial Grafting in Coronary Bypass?

Authors

  • Dror B. Leviner 

    1   Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel

  • Tom Ronai

    2   Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel

  • Ely Erez

    3   Division of Cardiac Surgery, Yale University, New Haven, Connecticut, United States

  • Guy Witberg

    4   Department of Cardiology, Rabin Medical Center, Petah Tikva, Central District, Israel

  • Dana Abraham

    1   Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel

  • Yaron Yishai

    5   Department of Cardiac Surgery, Soroka Medical Center, Beer Sheva, Southern District, Israel

  • Nili Stein

    6   Department of Biostatistics, Carmel Medical Center, Haifa, Israel

  • John D. Puskas

    7   Division of Cardiac Surgery, Emory University, Atlanta, Georgia, United States

  • Erez Sharoni

    1   Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
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Abstract

Background

Multiple arterial grafting (MAG) is associated with improved long-term outcomes. However, there are limited data on the benefit of total arterial revascularization (TAR).

Methods

Retrospective study of adult patients with multivessel disease undergoing isolated coronary artery bypass grafting (CABG) in three centers between January 1, 2009, and December 31, 2023. Patients were grouped according to the revascularization strategy (TAR vs. MAG). The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE). The cumulative incidence of MACCE was plotted using Kaplan Meier (KM) curves. The hazard ratio (HR) for TAG versus MAG was calculated using multivariate Cox models.

Results

Our cohort included 2,791 patients. About 1,048 (37.55%) underwent TAR and 1,743 (62.45%) underwent MAG, of whom 2,434 (87.21%) were male. Mean age was 61.6 ± 9.8 years in the TAR and 62.1 ± 9.1 years in the MAG. Median follow-up time was 101 months. The cumulative incidence of the primary outcome was 48.57% in the TAR and 42.4% in the MAG group. After multivariable adjustment, TAR had an HR of 1.05, 95% CI (0.93–1.18) for the primary outcome (p = 0.25). The mortality rate was 28.72% in the TAR and 23.06% in the MAG group.

Conclusion

TAR showed no benefit over MAG at midterm follow-up.

Keywords

total arterial revascularization - multiarterial grafting - coronary artery bypass grafting

Data Availability Statement

The data underlying this article will be shared on reasonable request to the corresponding author.


Authors' Contribution

D.B.L. contributed to writing—review and editing, supervision. T.R. contributed to writing—review and editing, investigation. E.E.: Investigation. G.W. contributed to investigation. D.A. contributed to investigation. Y.Y. contributed to investigation. N.S. contributed to formal analysis. J.D.P. contributed to supervision. E.S. contributed to writing—review and editing, supervision.




Publikationsverlauf

Eingereicht: 03. Mai 2025

Angenommen: 11. September 2025

Artikel online veröffentlicht:
26. September 2025

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