• Ana K Velez, Joseph K Canner, Eric Etchill, Katherine Giuliano, Diane E Alejo, Chun Choi, Ahmet Kilic, Stefano Schena, Glenn Joseph Robert Whitman, and Jennifer S Lawton.
• Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
• J. Am. Coll. Surg. 2021 Jun 1; 232 (6): 954-961.

BackgroundUse of multiple arterial grafts (MAGs) provides superior patency and long-term survival benefit compared with venous grafts during coronary artery bypass grafting (CABG). However, MAGs are used infrequently for CABG. We hypothesized that specific measures introduced at our institution would lead to an increase in the use of MAGs.Study DesignUse of MAGs before and after introduction of bundled measures was compared. Measures included increased education in arterial graft harvesting, inclusion as a quality metric, and hiring of surgeon champions. Patients younger than 70 years who underwent first time, isolated CABG using at least 1 arterial graft were included. Number and type of grafts used were compared between time periods using chi-square test. Secondary outcomes included postoperative complications. Complications were compared between time periods, as well as between MAG and non-MAG recipients before and after propensity score matching using Fisher exact test and univariate logistic regression. Multivariable logistic regression was used to determine patient characteristics associated with MAG use.ResultsThere were 2,169 patients included from 2012 to 2019. MAG use increased significantly after introduction of measures (21.1% to 41.9%; p < 0.001). Radial artery use with an internal mammary artery (0.3% to 16%; p < 0.001) and the use of triple arterial grafts increased significantly (0% to 2.4%; p < 0.001). MAG use in the entire cohort was associated with decreased 30-day mortality and postoperative cardiac arrest that was not significant after propensity matching.ConclusionsA programmatic emphasis on the use of MAGs for CABG is an effective method to increase its use.Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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