How did coronary artery bypass grafting (CABG) outcomes and grafting strategies evolve through the prolonged disruption of the COVID-19 pandemic? A retrospective cohort study published in the Journal of Cardiac Surgery evaluated 564 consecutive patients undergoing isolated CABG between 2019 and 2024, capturing practice patterns across four defined periods: PRE-COVID (2019-February 2020), COVID (February 2020-April 2022), POST-COVID (April 2022-December 2023), and LATE POST-COVID (2024). 

The analysis assessed in-hospital and 30-day mortality alongside conduit selection and limb-harvest complications. Mortality differed significantly across periods, rising from 0.8% in PRE-COVID to 3.8% during COVID and peaking at 8.0% in the POST-COVID phase, before declining to 1.8% in 2024 (P <0.01). Mortality remained elevated for nearly two years beyond the initial pandemic phase and normalized only in the LATE POST-COVID period.

Conduit strategies evolved in parallel. Radial artery (RA) use increased from 61.2% to 93.6% (P <0.001), while saphenous vein graft use declined from 64.5% to 19.1% (P <0.001). Total arterial revascularization (TAR) rose from 35.5% to 80.9% (P <0.001), with all TAR procedures performed using a simplified two-conduit arterial approach. Limb-harvest infection decreased from 7.4% to 0.9% (P=0.025).

Across the COVID-19 timeline, CABG mortality showed a delayed normalization, while arterial grafting increased steadily. The reduction in limb-harvest infection paralleled reduced saphenous vein use and does not indicate intrinsic superiority of the two-conduit TAR strategy.