Long-term results of sequential vein coronary artery bypass grafting compared with totally arterial myocardial revascularization: a propensity score-matched follow-up study

Garatti, Andrea; Castelvecchio, Serenella; Canziani, Alberto; Corain, Livio; Generali, Tommaso; Mossuto, Eugenio; Gagliardotto, Piervincenzo; Anastasia, Luigi; Salmaso, Luigi; Giacomazzi, Francesca; Menicanti, Lorenzo

doi:10.1093/ejcts/ezu057

Cited by 26 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies were excluded for the following reasons: no comparison between TAR and non‐TAR strategy (n = 32), sample population derived from a previously published and included series (n = 1), and lack of propensity score matching (n = 1). Consequently, 18 articles were included in our study . Mean age and mean body mass index of the included populations were 65.6 years (±7.6) and 27.1 (±1.7).…”

Section: Resultsmentioning

confidence: 99%

“…Of these studies, 10 described a BIMA usage of ≥80%. For this reason, they were assigned to the category “TAR with BIMA” . The remaining 4 studies were categorized as “TAR without BIMA” (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…These studies were assigned to the group “two arteries in TAR”. The remaining nine studies showed ≥2.50 arterial conduits and therefore, they were assigned to the “three arteries in TAR” group. The number of arterial conduits per patient in these nine studies were: Bisleri 2017 = 2.52, Buxton 2012 = 3.03, Buxton 2014 = 2.81, Formica = 3.00, Garatti = 3.20, Mohammadi = 3.00, Nasso = 3.10, Shi = 3.12, and Suzuki = 3.45 …”

Section: Resultsmentioning

confidence: 99%

“…Consequently, 18 articles were included in our study. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Mean age and mean body mass index of the included populations were 65.6 years (±7.6) and 27.1 (±1.7). Thirty percent of the population presented with diabetes and 18.9% were female patients (Table S1).…”

Section: Resultsmentioning

confidence: 99%

“…For this reason, they were assigned to the category "TAR with BIMA". 16,17,[21][22][23][25][26][27]30,31 The remaining 4 studies were categorized as "TAR without BIMA" 19,20,29,32 (Figure 1). The percentages of patients of the TAR group receiving BIMA in these four studies were: Buxton 2012 = 16% 19 ; Buxton 2014 = 36% 20 ; Royse = 0% 29 ; and Tatoulis = 22%.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

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

et al. 2019

View full text Add to dashboard Cite

Background and Aim of the Study We explored the current evidence available on total arterial revascularization (TAR) carrying out a meta‐analysis of propensity score‐matched studies comparing TAR versus non‐TAR strategy. Methods PubMed, EMBASE, and Google Scholar were searched for propensity score‐matched studies comparing TAR vs non‐TAR. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long‐term mortality. The Der‐Simonian and Laird method were used to compute the combined risk ratio (RR) of 30‐day mortality, deep sternal wound infection, and reoperation for bleeding. Results Eighteen TAR vs non‐TAR matched populations were included. Meta‐analysis showed a significant benefit in terms of long‐term survival of the TAR group over the non‐TAR group (HR: 0.73; 95% confidence interval [CI]: 0.68‐0.78). Better long‐term survival over non‐TAR strategy was confirmed by both subgroups: TAR with the bilateral internal mammary artery (BIMA) and TAR without BIMA. Meta‐regression suggests that TAR may offer a higher protective survival effect in diabetic patients (coefficient: −0.0063; 95% CI: −0.01 to 0.0006), when carried out with BIMA (coefficient: −0.15; 95% CI: −0.27 to −0.03) or using three arterial conduits (coefficient: −0.12; 95% CI: −0.25 to 0.007). A TAR strategy carried out using BIMA, differently from TAR without BIMA, increases the risk of deep sternal infection (RR: 1.44; 95% CI: 1.17‐1.77). Conclusions TAR provides a long‐term survival benefit compared with the non‐TAR strategy. Also, compared with TAR without BIMA, TAR with BIMA may offer a higher protective long‐term survival effect at the expense of a higher risk of sternal deep wound infection.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2019

View full text Add to dashboard Cite

show abstract

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

et al. 2020

View full text Add to dashboard Cite

IMPORTANCEThe optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.OBJECTIVE To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study. DESIGN, SETTING, AND PARTICIPANTSThis multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019. EXPOSURES Total arterial revascularization.MAIN OUTCOMES AND MEASURES Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome. RESULTSOf 49 404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4 [0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4 [0.5] vs 1.2 [0.4]; P < .01). In-hospital death (15 [0.7%] vs 21 [1.0%]; P = .32) did not differ between TAR vs non-TAR groups after propensity score matching. Throughout 8 years, TAR was associated with improved freedom from major adverse cardiac and cerebrovascular events (hazard ratio, 0.78; 95% CI, 0.68-0.89), death (hazard ratio, 0.80; 95% CI, 0.66-0.97), and myocardial infarction (hazard ratio, 0.69; 95% CI, 0.51-0.92). There was no difference in stroke and repeated revascularization.CONCLUSIONS AND RELEVANCE Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.

show abstract

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Magouliotis

Fergadi

Zotos

et al. 2022

Gen Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Objective We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG). Methods Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method. Results Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58–0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80–0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89–0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis. Conclusion The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.

show abstract

Long-term results of sequential vein coronary artery bypass grafting compared with totally arterial myocardial revascularization: a propensity score-matched follow-up study

Abstract: Sequential vein CABG appears to have good early and long-term clinical outcomes. Also, early and long-term incidence of acute MI was not significantly higher in the SV group. However, further studies with a larger population are warranted in order to confirm the present results.

Cited by 26 publications

References 22 publications

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

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

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

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Contact Info

Product

Resources

About