The Change of Coronary Grafting Strategy in a Single Institution Almost 20 Years Prior

Purpose: The predominant technique of coronary bypass grafting (CABG) worldwide is a single internal mammary artery and supplementary saphenous vein grafts (SVG). Exclusive use of total arterial revascularisation (TAR) is rare. Methods: A single centre experience 1996-2003 for CABG was analysed from institutional databases. Results: There were 8242 participants, with those receiving TAR (n = 6112) and any use of SVG (n = 2100). Radial artery (RA) in SVG participants was 65.8% and for TAR was 86.1%. Of 25828 anastomoses performed, IMA was 44.1%, RA 44.4% and SVG 11.5%. Use of RA in 1996 was 58% and thereafter was > 81.5%. In 1996 TAR was 40.2% but in all the remaining years TAR was 73.4 – 86.7%. TAR by surgeon was as low as 7.5% and 27.2% in two who retired in 1996 for the remainder was 56.2 – 97.9%. Conclusion: A dramatic change in practice occurred in 1996 which was sustained and broadly applicable for the remainder of the study period. High rates of total arterial revascularisation were achieved.