Multiarterial Grafting in Redo Coronary Artery Bypass Grafting: Type of Arterial Conduit and Patient Sex Determine Benefit

In this article, the authors analyzed 6,693 redo coronary artery bypass grafting (CABG) operations performed between 1980 and 2020 at the Cleveland Clinic to determine whether multiarterial grafting (MAG) provides a survival benefit over single arterial grafting (SAG). Using propensity-matched cohorts (2,005 pairs), they found that MAG resulted in lower in-hospital mortality (1.7 percent vs 2.8 percent) and comparable morbidity. Long-term survival was significantly better after MAG, particularly in men receiving bilateral internal thoracic artery (ITA) grafts, with a 20-year survival rate of 31 percent compared to 25 percent after SAG. No clear survival advantage was observed in women or when non-ITA conduits were used. The authors note that CABG is technically more complex in women, whose smaller arteries and limited collateralization may partly explain the limited observed benefit.