Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

Abstract

Background and Aim of the Study: Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. Methods and Results: In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. Conclusions: In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement. K E Y W O R D S CABG, coronary artery bypass grafting, coronary artery disease, multiarterial revascularization, total arterial revascularization

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

“…After demonstrating the safety and reproducibility of this approach in a case series, and through significant technological improvements of the following generations of the da Vinci robotic system, multiple conduit harvesting for more complex, off-pump grafting strategies became possible. [ 53 – 55 ] It has been extensively demonstrated that robotic-assisted, endoscopic, multivessel CABG procedures are safe, feasible and reproducible and lead to excellent outcomes. [ 6 , 8 , 56 , 57 ]…”

Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies

“…Total arterial grafting is more beneficial in both short and long-term outcomes and its use should be encouraged. 4 , 5 , 24 , 26 This technique minimizes the risk of stroke and has better patency. Drawbacks of this approach include DSWI and longer procedural time, as total arterial grafting is a more challenging surgical technique.…”

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques

“… 33 , 34 Later on, significant technological improvements in the da Vinci robotic system enabled surgeons to perform off-pump multiarterial TE-CABG. 35 The value of TE-CABG versus RA-CABG is not limited to the presence or absence of an incision required to perform the surgery but rather to the possibility of expanding the procedure to multivessel grafting by facilitating RITA harvest and performing multiple anastomoses. 36 …”