Multiple Arterial Graft Use in Coronary Artery Bypass Surgery: Surgeon Perspective vs Practice

BACKGROUND Despite supportive evidence and guidelines, the use of multiple arterial grafts (MAGs) in coronary artery bypass grafting remains low. We sought to determine surgeon perception of personal MAG use and compare this with actual MAG use. METHODS We conducted a statewide surgeon survey of MAG use, presence of a hospital MAG protocol, and barriers for MAG use, with a response rate of 78% (n [ 25). Surgeon survey responses were compared with actual Society of Thoracic Surgeons patient data from January 1, 2017, to December 31, 2020 using chi(2) or Fisher's exact tests. RESULTS Of 5299 patients who had first-time, nonemergent, isolated coronary artery bypass grafting (>= 2 grafts) by responding surgeons, 16% received MAG (n [ 825). MAG use in patients whose surgeons self-designated as routine MAG users was 21% vs 7% for nonroutine users. Surgeons with a hospital protocol for MAG use utilized MAG more often (18% vs 14%, P[.001). Surgeons who were unconvinced by the data on the benefits of MAGs used MAGs in 11% vs 22% in surgeons who were convinced. MAG use increased over time, particularly from before to after the survey (13.1% vs 30.5%, P <.001). CONCLUSIONS Although MAG use increased over time, barriers to routine use remain. In surgeons who reported routine use, only 21% of their patients received MAGs. Hospital protocols, education, and increased awareness may reduce barriers to use and encourage evidence-based clinical practice.

Automated summary

Despite supportive evidence and guidelines, the utilization of multiple arterial grafts (MAGs) in coronary artery bypass grafting remains low. There is a discrepancy between surgeons' perception and actual use of MAGs, and only a small proportion of hospitals have protocols for MAG use. Information dissemination, medical education, and increased awareness may help reduce barriers to utilization.