Total arterial myocardial revascularization (TAR) should be considered the treatment of choice in the context of coronary patients with three-vessel disease, as it has gained consistent clinical and scientific evidence on its superiority over the conventional strategy with a single internal thoracic artery. However, TAR is still not widely accepted and accounts for less than 15% of CABG procedures worldwide. Different factors have contributed to the inadequate implementation of TAR, including the more time-consuming procedure in harvesting more than one arterial conduit, fear of wound complications in using BITA, and expanding indications in percutaneous revascularization reducing the number of coronary patients referred for surgery. Furthermore, the attention of surgeons has shifted towards more appealing surgical treatments, such as minimally invasive valve surgery, rather than complex and sophisticated CABG.
Therefore, we are hereby launching a project entitled, "Surgical strategies for total arterial myocardial revascularization" in order to discuss and define the state of the art of TAR. This project ranges from required skills, pitfalls, and troubleshooting about technical aspects to strategies necessary for significantly improving long-term outcomes. Major topics include advanced skills in harvesting arterial conduits, choosing the right conduits for target vessels, On vs Off-pump TAR, TAR in reduced EF, and how to establish a program of minimally invasive TAR.
Prof. Massimo Bonacchi and Dr. Francesco Cabrucci
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