New conduits for coronary artery bypass: great promise for improved outcome from coronary artery surgery.

The internal mammary artery is the conduit of choice for coronary artery bypass, with patency at about 95%, 10 years after implantation. Patients who receive this graft survive longer and have fewer cardiac complications than those who receive only saphenous vein bypass grafts. Surgeons are currently studying other arteries that may be used as bypass conduits. The gastroepiploic artery on the greater curve of the stomach demonstrates the greatest promise, with patency greater than 90% at 3 to 4 years. The radial artery, used in the 1970s but abandoned due to poor results, may be due for a revival, since it has up to 95% patency at one year. The inferior epigastric artery (located posterior to the rectus muscle) is also under consideration, but few results are available. However, it appears that about 80% are patent at one year. The role of these alternative conduits has not yet been clarified in the management of coronary bypass patients. However, these preliminary observations suggest that increased use of these extremely durable bypass conduits may further improve surgical outcomes.