Conduits in coronary artery bypass grafting

Coronary artery bypass grafting (CABG) remains the gold standard revascularization method in patients with complex multi-vessel coronary artery disease. Among various technical aspects that contribute to the long-term survival of patients after CABG, conduit selection plays an important role. Hence, choice and use of various conduits are important in determining long-term excellence after CABG. CABG conventionally is performed utilizing the left internal thoracic artery (LITA), which is grafted to the left anterior descending artery (LAD) and great saphenous vein (GSV) as conduit for the other coronary targets. Recent studies have demonstrated that almost two thirds CABG worldwide are performed with a single internal thoracic artery (SITA) and vein grafts. Research demonstrates that addition of one or more arterial conduit to other targets to complement the LITA to LAD may provide improvement in survival and other quality related outcomes. Results between randomized controlled trials and observational studies vary. Herein, we summarize relevant characteristics of the different conduits utilized in coronary artery bypass surgery. We present an overview of conduit biology and popular hypotheses to explain the superiority of arterial conduit for CABG. We also present a brief synopsis of long term clinical outcome for CABG according to conduit configuration. We have divided the review into sections; each section deals with a particular approach regarding conduit use.