Observational evidence shows that the use of multiple arterial grafts (MAG) is associated with longer postoperative survival and improved clinical outcomes. The current European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommend the use of MAG in appropriate patients. However, a significant volume-to-outcome relationship exists for MAG, and lack of sufficient experience is associated with increased operative risk. A stepwise approach to building experience with MAG allows successful implementation of this technique into routine coronary surgery practice.
Gaudino MFL, Sandner S, Bonalumi G, Lawton JS, Fremes SE; Coronary Task Force of the European Association for Cardio-Thoracic Surgery. How to build a multi-arterial coronary artery bypass programme: a stepwise approach. Eur J Cardiothorac Surg 2020 Dec 1;58(6):1111-1117.doi: 10.1093/ejcts/ezaa377.