Angiographic Patency of Coronary Artery Bypass Conduits: An Updated Network Meta-Analysis of Randomized Trials

Abstract

Introduction The second best conduit for coronary artery bypass grafting is uncertain. The objective of this study is to determine the second best conduit according to graft patency results from randomized controlled trials using a network meta-analysis. Methods A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency rate of the no-touch saphenous vein (NT-SV), the radial artery (RA), the right internal thoracic artery (RITA), and the gastroepiploic artery (GEA) in reference to the conventionally harvested saphenous vein (CON-SV). The primary outcome was graft occlusion, and the secondary outcome was all-cause mortality. Results A total of 859 studies were retrieved, of which 18 were included. A total of 6,543 patients and 8,272 grafts were analyzed. The weighted mean angiographic follow-up time was 3.5 years. Compared with CON-SV, RA (incidence rate ratio [IRR] 0.56; 95% confidence interval [CI], 0.43-0.74) and NT-SV (IRR 0.56; 95% CI, 0.44-0.70) demonstrated lower graft occlusion. NT-SV and RA were ranked as the best conduits (rank score for NT-SV 0.88 vs. 0.87 for RA, 0.29 for GEA, 0.27 for CON-SV, and 0.20 for RITA). There was no significant difference in late mortality between different conduit types. Conclusion RA and NT-SV are associated with significantly lower graft occlusion rates and are comparably ranked as the best conduit for patency.

Unanswered questions on coronary artery graft patency and clinical outcomes

“…Compared with the conventionally harvested SVG, only the radial artery [incidence rate ratio (IRR) 0.54, 95% CI 0.35–0.82] and no-touch SVG (IRR 0.55, 95% CI 0.39–0.78), but not the RITA (IRR 1.06, 95% CI 0.73–1.54) or GEA (IRR 0.98, 95% CI 0.64–1.42), were associated with significantly lower graft occlusion rates. Similar results were found in an updated network meta-analysis of 18 randomized trials including 8272 grafts at a mean angiographic follow-up of 3.5 years [18 ▪ ].…”

Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression

“…25 The rate of RIMA graft occlusion in our study was higher than the reported rate in the literature (68 vs. 89%, respectively) that could be explained by differences in surgical technique (such as Y-grafting). 26 In our previous study, we studied 70 consecutive patients treated with CABG who underwent clinically indicated ICA after surgery with the aim of investigating the functional progression of CAD in native vessels and assessing the relationship between the preoperative angiography-derived FFR value and graft occlusion. 15 The population of this study was limited to 70 patients because ICA after CABG was an inclusion criterion.…”

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

“…Further, Benedetto et al evaluated the angiographic patency of the RITA, the radial artery, and the SVG through a network meta-analysis of nine randomized controlled trials (N = 145 RITA, 871 radial arteries, 845 SVGs): at follow-up, patency rates were superior for RITA compared to the radial artery, whereas both grafts were found to be superior to the SVG [ 22 ]. A more recent network meta-analysis by Deng et al [ 23 ] of 18 trials with a total of 8272 grafts and a weighted mean angiographic follow-up of 3.5 years found that the radial artery (IRR 0.56 [0.43–0.74]) and no-touch SVG (IRR 0.56 [0.44–0.70]) were associated with reduced graft occlusion compared to the conventionally harvested SVG.…”