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This is a randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation.

ART (Arterial Revascularisation Trial) is led by Professor David Taggart, Professor of Cardiovascular Surgery, University of Oxford.

AIM

The aim of the ART study is to determine if the use of both internal mammary arteries (IMA) during coronary artery bypass graft (CABG) surgery improves survival, and reduces the need for further intervention (including surgery) compared to using one mammary artery. Patients will be followed up for 10 years after surgery.

TRIAL STATUS

  • ART is currently in follow-up and the data collection is being coordinated through the Oxford Clinical Trials Research Unit (OCTRU). All CRFs should be sent to OCTRU for processing at the following address: ART, OCTRU, Botnar Research Centre, Nuffield Orthopaedic Centre, Old Road, Headington, OX3 7LD
  • If there are any SAE forms/death report forms, please fax them to the ART team on: 01865 572398.
  • 3102 patients were enrolled into ART between June 30th 2004 and December 20th 2007 in 28 cardiac surgery centres in seven countries worldwide (Australia, Austria, Brazil, India, Italy, Poland, UK).
  • The primary outcome of ART is survival at 10 years and therefore the study will be completed in 2017 when all patients have been followed up for 10 years.
  • The clinical outcomes at 1 year have been reported and showed similar clinical outcomes for both bilateral IMA grafts and single IMA grafts. This provided evidence that the use of bilateral IMA grafts is feasible on a routine basis.
  • The effects of on-pump versus off-pump surgery in ART have also been reported and showed that the outcomes of contemporary CABG are excellent with low mortality, stroke, myocardial infarction and need for wound reconstruction and repeat revascularisation whether performed on-pump or off-pump.

PURPOSE 

Coronary artery bypass grafting (CABG) is well established as the best treatment for those with multiple diseased blood vessels of the heart (coronary heart disease).  Most patients undergoing CABG require 3 new blood vessels (grafts).  The standard operation, used in 80%-90% of all patients, is to use one of the mammary arteries (from inside the chest) and additional veins from the leg or an artery from the arm.

CABG provides excellent short and intermediate term success but its long-term success may be limited by failure of the veins that have been used to bypass the blood vessels of the heart. Ten years after CABG around ½ of vein grafts have become blocked or diseased although current drug therapy such as aspirin and statins (which lower cholesterol) may reduce this failure.  Blocked or diseased vein grafts means that the patient may develop recurrent angina (chest pain) and may require further treatment including the possibility of another operation. There is some circumstantial (but no definite) evidence that if both of the mammary arteries are used in the CABG operation instead of just one it may improve the longer-term outcome.


Our team