Long term outcomes of radial artery grafting in patients undergoing coronary artery bypass surgery

Single arterial left internal thoracic artery (LITA) based coronary artery bypass surgery (LITA-SABG) has been the principal revascularization strategy for over 25 years across all patient demographics. In line with the current emphasis being placed on personalized medicine, which tailors individual, patient-specific therapy to optimize outcomes, coronary artery bypass grafting (CABG) techniques have also evolved to achieve enhanced results among specific groups of patients with coronary artery disease. Most notable has been the development of multi-arterial bypass grafting (MABG) techniques, using either the radial artery (RA) or the right internal thoracic artery (RITA) in conjunction with the LITA, as both techniques have been shown to enhance long term survival of CABG patients. This article reviews the latest data on the long-term outcomes of RA-MABG and considers its impact in various sub-cohorts of CABG that are increasingly being treated by cardiac surgeons. The primary aim of this review is to highlight the advantages of RA-MABG over LITA-SABG and thereby potentiate its adoption into clinical practice. Our secondary aim is to summarize the results of RA-MABG in specific CABG sub-cohorts, to more closely align CABG surgery with the emerging consensus that personalized medicine enhances healthcare value.