Multiple versus single arterial grafts in coronary artery bypass grafting among Veterans

Abstract: Background: There is mounting evidence of the long‐term benefits of multiple versus single arterial grafts (MAG vs. SAG) during coronary artery bypass grafting (CABG). However, the adoption of MAG has been low in nonfederal institutions as reported by the Society of Thoracic Surgeons Database, and adoption and results from lower volume federal institutions have rarely been reported. Here, we report our long‐term clinical outcomes of MAG in a veteran population. Methods: We collected data on 521 consecutive CABG patients from 2013 to 2023. The decision for MAG was at the discretion of the operating surgeon with use of skeletonized bilateral internal mammary arteries (BIMAs) when applicable and procedures included both on‐pump and off‐pump CABG. The Fisher exact test was used to compare categorical variables, and the Wilcoxon rank sum test was used to compare continuous variables. A Mann–Kendall statistical test was used to test the trend of MAG use over time, and a Cox proportional hazards model was used to compare mortality between the groups after adjusting for confounders. Results: Our patients had a mean (SD) age of 67.3 (7.2) years with 2.72 (0.68) diseased coronary vessels. Over the course of the study, 58% of the patients received MAG. There was a significant increase of MAG over time (p = 0.03), with 0% prior to 2013, 69.1% by 2015, and settling at 80.0% utilization in 2022. Patients who received MAG had a lower prevalence of chronic kidney disease and history of myocardial infarction. Patients who received MAG received significantly more total bypass grafts. Right internal mammary artery was utilized 69.4% and radial artery 32.9% of the time in MAG cases. There were no differences in short‐term mortality or sternal wound infections between the two groups. However, there was improved long‐term mortality seen as early as 5 years with MAG. Conclusions: In a lower‐volume federal center, there was a significant increase in MAG utilization over time and improved long‐term survival for patients receiving MAG than SAG with no differences in short‐term mortality or sternal wound infection.