How Arterial Grafts Outperform, Vein Grafts in Long-Term CABG Success Rates?

Arterial grafts, particularly the internal mammary artery, improve long-term CABG success by offering superior durability. Patency sits above 90% at 10 years. Saphenous vein grafts-Roughly 50–60% in the same window. Arteries fight off plaque, push survival up, and bring MACE rates down.

The internal mammary goes to the LAD. This is the standard recommendation.Tack on a second arterial conduit, radial or right internal mammary, and you stretch that durability across the rest of the bypass too.

According to Dr. Vishal Khullar, Heart Bypass Surgeon in Mumbai, Choosing the left internal mammary artery for the LAD isn’t preference, it’s standard of care, and adding a second arterial conduit gives the patient years of additional protection.

Younger patients. Hands down. They’re the ones living with this bypass for thirty, forty years. But age isn’t everything.

• Diabetics: Vein grafts fail fast in these patients. Arterial conduits give them a survival edge vein-heavy bypasses can’t touch
• Patients under 65: Anyone with 15+ years ahead of them gets the biggest payoff from a second or third arterial conduit past the LIMA
• Multi-vessel disease: BIMA plus a radial hits all three territories with conduits that just don’t quit on you the way veins do
• Redo candidates: People likely to need another procedure later. Arterial grafts cut the odds of a second surgery within ten years

Total arterial CABG is a technically demanding procedure that takes longer to perform and requires significant surgical experience for safe execution. Consistent outcomes typically require hundreds of completed cases, not a few dozen. In patients with complex anatomy, redo cardiac surgery planning often favors arterial conduits from the start. 

Dr. Vishal Khullar trained at Cleveland Clinic. Then served as Senior Associate Consultant at Mayo Clinic, Rochester. Thirty plus years in. 7000+ surgeries done. He’s the best cardiac surgeon in Mumbai people call for complex coronary work, BIMA grafting, total arterial CABG.

Every patient gets a graft plan tied to their age, diabetes, life expectancy. No template. A lot of his bypass cases run on arterial conduits only, harvested from the chest. That’s what real long-term outcomes need.

• National Heart, Lung, and Blood Institute – Coronary Artery Bypass Grafting
• PubMed – Long-term outcomes of arterial versus venous conduits in CABG