Impact of total arterial revascularization on long term survival: A systematic review and meta-analysis of 130,305 patients

Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

“…Thus, our analysis pooled data from 12 874 patients receiving only arterial grafts matched with 12702 patients receiving arterial plus venous grafts. The significant long‐term survival benefit we have documented in patients with TAR is consistent with that of a previous meta‐analysis …”

“…The significant longterm survival benefit we have documented in patients with TAR is consistent with that of a previous meta-analysis. 37 F I G U R E 4 Meta-regression analysis of the use of three versus two arterial conduits in TAR surgery on logarithmic hazard ratio for long-term mortality among patients assigned to total arterial revascularization versus non-total arterial revascularization (coefficient: −0.12; 95% CI: −0.25 to 0.007; P: 0.06) F I G U R E 5 Meta-regression analysis of the use of BIMA in TAR surgery on logarithmic hazard ratio for long-term mortality among patients assigned to total arterial revascularization versus non-total arterial revascularization (coefficient: −0.15; 95% CI: −0.27 to −0.03; P: 0.02) F I G U R E 6 Forest plot of 30-day mortality analysis. BIMA, bilateral internal thoracic artery; RR, risk ratio; TAR, total arterial revascularization F I G U R E 7 Forest plot of reoperation for bleeding analysis.…”

Right for the Wrong Reasons: Implications of Data Insufficiency in Bilateral Versus Single Internal Thoracic Artery Grafting Analysis

“…Improvements in the long‐term efficacy of CABG remain limited by (saphenous) vein graft failure and progression of native artery atherosclerosis . Nearly 50% of coronary bypass vein grafts will have failed after 10 years, compared with the >90% patency rate exhibited by left internal thoracic artery (LITA) grafts, contributing to long‐term mortality and morbidity in patients undergoing CABG as angina recurrence, myocardial infarction, and repeat revascularization …”

“…6 Nearly 50% of coronary bypass vein grafts will have failed after 10 years, compared with the >90% patency rate exhibited by left internal thoracic artery (LITA) grafts, contributing to long-term mortality and morbidity in patients undergoing CABG as angina recurrence, myocardial infarction, and repeat revascularization. 6,7 Given these limitations of the use of venous coronary bypass grafts, an inflection point in the history of surgical coronary revascularization occurred in 1986 with the definitive demonstration of a significant survival benefit with the use of LITA compared with saphenous vein grafts to the left anterior descending coronary artery (LAD). 8 Later studies suggested a lower rate of cardiac events and death from any cause starting as early as 3 to 4 years after surgery.…”

Commentary: Total arterial revascularization: Is it for everyone?

“…Most of the data supporting increased survival with MAG are derived from retrospective, nonrandomized studies and meta-analyses with variability in propensity matching and selection bias. 5,6 The patients are younger with few comorbidities. All surgeons are aware that good patients make good surgeons.…”