Coronary bypass grafting with bilateral internal thoracic arteries and the right gastroepiploic artery.

Now that coronary artery bypass grafting has entered its fourth decade, cardiac surgeons unanimously agree that arterial grafts yield a more satisfactory long-term clinical outcome than do autologous saphenous vein grafts. With time, venous grafts are vulnerable to accelerated atherosclerosis, which may necessitate high-risk repeat coronary bypass surgery. In contrast, arterial grafts are highly resistant to atherosclerosis. If patent immediately after surgery, they tend to remain patent indefinitely; if angina recurs, it is usually manageable with medical therapy, so repeat coronary bypass may be avoided.