The second best arterial graft to the left coronary system in off-pump bypass surgery: a propensity analysis of the radial artery with a proximal anastomosis to the ascending aorta versus the right internal thoracic artery

Abstract

The RA anastomosed to the aorta appears to have good long-term outcomes, similar to the RITA as the second arterial graft. Furthermore, the choice of RA avoids sternal complications and shortens the operation time compared to the use of BITA.

Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term survival

“…The study by Ruttmann et al 8 reported the highest effect size in a relatively younger population (mean age 57 years), with a relatively low prevalence of women (10%) and diabetes mellitus (20%). At the other extreme is the study by Tsuneyoshi et al, 12 which reported the lowest effect size in a relatively older population (mean age 68 years), with a higher prevalence of women ($20%) and diabetes mellitus ($50%). Also, Tranbaugh et al 11 failed to show any benefit from RITA.…”

“…Pooled estimates from unmatched populations supported a survival benefit of RITA over RA (HR, 0.74; 95% CI, 0.56-0.98; P ¼ .03; I 2 ¼ 77.5%; Figure E4). Subgroup analysis showed that, compared with RA, the use of RITA was associated with better longterm survival when used to graft either the left coronary artery system only (HR, 0.81; 95% CI, 0.60-1.10) or both the left and right coronary systems (HR, 0.56; 95% CI, 0.38-0.81; test for subgroup differences P ¼ .12; Figure E5), and no significant differences were found between studies where skeletonized harvesting [5][6][7][8]10,12 (HR, 0.67; 95% CI, 0.50-0.89) versus pedicled harvesting only 9,11 was used (test for subgroup differences P ¼ .22).…”

“…Low-to-moderate heterogeneity among studies was found (I 2 ¼ 43.4%; 95% CI, 0%-76.2%). Subgroup analysis according to the internal thoracic artery harvesting technique showed that RITA was associated with a significant 3-fold increased risk of sternal wound complication when pedicled harvesting only was used 9,11 (OR, 3.18; 95% CI, 1.34-7.57), whereas the 2 groups were comparable in studies where a skeletonized approach was used [6][7][8]10,12 (OR, 1.07; 95% CI, 0.67-1.71) (test for subgroup differences P ¼ .12). No publication bias was found (P ¼ .17; Figure E2, B).…”

“…After evaluating the full-text articles, we excluded 6 observational studies [20][21][22][23][24][25] that did not perform PSM adjustment, and 1 RCT, the RAPCO trial 3 (Table E2). A total of 8 PSM studies [5][6][7][8][9][10][11][12] were finally selected for the systematic review and meta-analysis. Of note, the study population in the RAPCO trial 3 was also part of a large Australian multicenter registry 10 included in the main analysis.…”

“…4 Several large PSM studies comparing RITA with RA have been recently published with inconclusive findings. [5][6][7][8][9][10][11][12] Here, we propose to overcome the potential limitations related to underpowered individual reports by conducting a meta-analysis of PSM studies comparing RITAwith RA as a second arterial conduit on long-term survival in patients undergoing CABG.…”