Patency and adverse outcomes of sequential vs. individual saphenous vein grafts in coronary artery bypass: A meta-analysis

Abstract

ObjectivesTo undertake a systematic review and meta-analysis of cohort studies to compare the patency and adverse outcomes of sequential and individual saphenous vein grafts (SVGs) in coronary artery bypass grafting (CABG).MethodsWe searched PubMed, Embase, and the Cochrane Library for cohort studies. Endpoints for vein graft failure, perioperative and follow-up adverse events were extracted as risk ratio (RR) with 95% confidence intervals (95% CI). Statistical heterogeneity across the studies was examined using the I2 statistic. Potential of publication bias was evaluated quantitatively by the Egger's test. Sensitivity analysis was also performed to assess the robustness of our outcomes.ResultsThe 15 studies were analyzed, including 22,004 patients, 4,580 grafts, and seven different adverse events under individual or sequential CABG. The sequential group had inferior graft failure (RR = 0.68; 95% CI, 0.60–0.77) and long-term mortality (RR = 0.76; 95%CI, 0.61–0.95), but with an increased risk of perioperative repeat revascularization (RR = 1.58; 95%CI, 1.16–2.14) than the individual group.ConclusionTaken together, our analysis of the aggregated evidence comparing the sequential and individual saphenous vein grafts for coronary heart disease patients showed that the use of the sequential graft was associated with inferior graft failure and long-term mortality respectively, but with an increased risk of perioperative repeat revascularization. According to our study, both surgical techniques have their own advantages in efficacy and safety, and the selection of surgical techniques should be based on patients and surgeons. Sequential saphenous vein grafts should be more recommended to experienced surgeons in order to both reduce perioperative adverse events and improve long-term patency.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022326992.

Saphenous Vein Tributaries in Sequential Vein Grafting for Coronary Artery Disease

“…However, neointimal hyperplasia has been shown to be the leading cause of graft failure in the rst two years (10)(11)(12). Sequential vein grafting aims to revascularize multiple territories with one proximal anastomosis, allowing for lesser aortic manipulation (13). This technique was rst described by Flemma et al in 1971; subsequently, a detailed description was provided by Bartley and his colleagues (14,15).…”

“…It is recommended that experienced surgeons perform the challenging side-to-side anastomosis in sequential vein grafting to avoid the risk of perioperative cardiac events recorded with sequential vein grafting (13). Creating an anastomosis with a side branch is a much easier technique for novice surgeons, allowing the scope for broader practice of this technique.…”