Total Arterial Revascularization

Abstract

Total arterial revascularization (TAR) has been shown to improve both short- and long-term mortality in coronary artery bypass grafting patients when compared with a single internal thoracic artery (ITA) and vein grafts (Buxton, 2014; Zacharias, 2009). This benefit has been demonstrated in both younger and older (>70 years) patients (Habib, 2012). TAR typically uses bilateral ITA grafts, the left as a pedicled graft and the right either pedicled, free or as a Y graft. Skeletonization of the ITA grafts increases available length, decreases devascularization of the chest wall and may decrease sternal wound infection rates. Radial artery grafts are a very versatile conduit also commonly used in TAR. They are long enough to reach any target as an aortocoronary graft; alternatively, they lend themselves well to Y grafts, T grafts and sequential grafts.