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The ten-year outcomes of the Arterial Revascularisation Trial (ART), conducted by the Nuffield Department of Surgical Sciences (NDS) at Oxford University, have been published in the New England Journal of Medicine.

ART is one of the largest randomised trials of two surgical procedures ever undertaken in cardiac surgery, comparing single versus bilateral internal thoracic artery grafts in patients undergoing coronary artery bypass graft surgery (CABG). According to the study, published in the 31 January issue of the New England Journal of Medicine, there is no difference in the rate of death from any cause at 10 years for patients undergoing CABG with bilateral or single internal-thoracic-artery grafting.

Professor David Taggart, Chief Investigator and Professor of Cardiac Surgery from NDS, and colleagues randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting (1,548 and 1,554 patients, respectively).

The researchers found that 13.9 percent of patients in the bilateral-graft group received only a single internal-thoracic-artery graft, while 21.8 percent of patients in the single-graft group also received a radial-artery graft. In the intention-to-treat analysis, 20.3 and 21.2 percent of patients in the bilateral- and single-graft groups died from any cause (hazard ratio, 0.96; 95 percent confidence interval, 0.82 to 1.12; P = 0.62). Overall, 24.9 and 27.3 percent of patients in the bilateral-graft and single-graft groups, respectively, had an event with respect to the secondary outcome (composite of death, myocardial infarction, or stroke; hazard ratio, 0.90; 95 percent confidence interval, 0.79 to 1.03).

Professor Taggart said: “ART is one the largest randomised trials with the longest duration of follow-up ever undertaken in cardiac surgery to guide future practice for CABG. While the trial did not show that using two internal thoracic arteries is superior to one it confirmed the long-term safety of this approach. The trial also raises the possibility that two arterial grafts (internal thoracic or radial) may still provide better outcomes than a single arterial graft for patients undergoing CABG surgery but we need further research to confirm this. We are immensely grateful to all patients and research collaborators for supporting this important trial over a 15-year period and especially to the late Professor Doug Altman, senior medical statistician at University of Oxford, who inspired us all. The support of our funders the British Heart Foundation, the UK Medical Research Council and the UK National Institute of Health Research is also gratefully acknowledged as a key element of running this successful long-term trial.”

 

Largest cardiac surgery trials.jpg

Prepared by Professor Mario Gaudino at the Weill Cornell Medicine, New York - Presbyterian Hospital

 

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