Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

Rocha, Rodolfo V.; Tam, Derrick Y.; Karkhanis, Reena; Wang, Xuesong; Austin, Peter C.; Ko, Dennis T.; Gaudino, Mario; Royse, Alistair; Fremes, Stephen E.

doi:10.1001/jamacardio.2019.6104

Cited by 60 publications

(54 citation statements)

References 39 publications

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“…Furthermore, there trended to decreased cardiovascular events in the MABG, with the ratio of SVG increased. These ndings were consistent with the subgroup analysis in general CABG population study by Rocha and colleagues [34]. Whereas, further investigations were needed, as potential type II error associated with a small sample size may occur when creating subgroups in a sensitivity analysis.…”

Section: Discussionsupporting

confidence: 87%

Multiple Arterial Conduits for Multi-Vessel Coronary Artery Bypass Graft in Patients with Mild to Moderate Left Ventricular Systolic Dysfunction: A Multicenter Retrospective Study

Zhang¹,

Chen²,

Zhao

et al. 2020

Preprint

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Background: Advantages of multiple arterial conduits for coronary artery bypass graft (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD).Methods: This multicenter study using propensity score matching (PSM) took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with LVSD, underwent primary, isolated multi-vessel CABG with left internal thoracic artery (LITA). The in-hospital and mid-term outcomes of MABG versus traditional LITA supplemented by saphenous vein grafts [single arterial CABG (SABG)] were compared. The primary endpoints were death from all causes and death from cardiovascular causes. The secondary endpoints were stroke, myocardial infarction (MI) and repeat revascularization, and a composite of all mentioned outcomes, including death from all causes [major adverse events (MAEs)]. Sternal wound infection was included with 6 months of follow-up after surgery.Results: 243 and 676 patients were formed in the MABG and SABG after PSM in a 1:3 ratio. Compared with SABG, MABG was associated with lower rate of MAEs (HR, 0.64; 95% CI, 0.44-0.94; P=0.02), MI (HR, 0.39; 95% CI, 0.16-0.99; P=0.05) and repeat revascularization (HR, 0.42; 95% CI, 0.18-0.97; P=0.03). There was no difference in the rate of death, stroke, and sternal wound infection.Conclusions: In patients with mild to moderate LVSD, MABG was associated with reduced mid-term rate of MAEs and cardiovascular events, but without reduced rate of death and stroke. MABG did not increase sternal wound infection rate.

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Section: Discussionsupporting

confidence: 87%

Multiple Arterial Conduits for Multi-Vessel Coronary Artery Bypass Graft in Patients with Mild to Moderate Left Ventricular Systolic Dysfunction: A Multicenter Retrospective Study

Zhang¹,

Chen²,

Zhao

et al. 2020

Preprint

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“…Furthermore, there trended to decreased cardiovascular events in MABG, with the ratio of SVG increased. These findings were consistent with the study by Rocha et al [ 34 ]. Whereas, further investigations are needed, as potential type II error may still come from a small sample size when creating subgroup analysis.…”

Section: Discussionsupporting

confidence: 94%

Multiple arterial conduits for multi-vessel coronary artery bypass grafting in patients with mild to moderate left ventricular systolic dysfunction: a multicenter retrospective study

Zhang

Chen

Zhao

et al. 2021

J Cardiothorac Surg

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Background Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD). Methods This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery. Results 243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44–0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16–0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18–0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection. Conclusions MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG.

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“…A total of 2,473 citations were identified, of which 57 studies were potentially relevant and retrieved as full-text. Fourteen publications [ 9 , 14 - 26 ] fulfilled our eligibility criteria. Interobserver reliability of study relevance was excellent (Kappa=0.86).…”

Section: Resultsmentioning

confidence: 99%

Total Arterial Coronary Bypass Graft Surgery is Associated with Better Long-Term Survival in Patients with Multivessel Coronary Artery Disease: a Systematic Review with Meta-Analysis

Rayol¹,

Eynde

Cavalcanti³

et al. 2021

Braz J Cardiovasc Surg

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Introduction The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. Results Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P <0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome. Conclusion This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.

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Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

Cited by 60 publications

References 39 publications

Multiple Arterial Conduits for Multi-Vessel Coronary Artery Bypass Graft in Patients with Mild to Moderate Left Ventricular Systolic Dysfunction: A Multicenter Retrospective Study

Multiple Arterial Conduits for Multi-Vessel Coronary Artery Bypass Graft in Patients with Mild to Moderate Left Ventricular Systolic Dysfunction: A Multicenter Retrospective Study

Multiple arterial conduits for multi-vessel coronary artery bypass grafting in patients with mild to moderate left ventricular systolic dysfunction: a multicenter retrospective study

Total Arterial Coronary Bypass Graft Surgery is Associated with Better Long-Term Survival in Patients with Multivessel Coronary Artery Disease: a Systematic Review with Meta-Analysis

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