Assessing the Long-term Patency and Clinical Outcomes of Venous and Arterial Grafts Used in Coronary Artery Bypass Grafting: A Meta-analysis

Abstract

IntroductionThe long-term patency of the grafts used during the coronary artery bypass grafting (CABG) is one of the most significant predictors of the clinical outcomes. The gold standard graft used during CABG with the best long-term patency rate and the better clinical outcomes is left internal thoracic artery (LITA) grafted to the left coronary artery (LCA). The controversy lies in choosing the second-best conduit for the non-left coronary artery (NLCA) with similar patency rate as LITA. This meta-analysis examines the long-term patency and clinical outcomes of all arterial grafts versus all venous grafts used during the CABG.MethodsA comprehensive literature search of all published randomized control trials (RCTs) assessing long-term patency and clinical outcomes of grafts used in CABG was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2018). Keywords searched included combinations of “CABG”, “venous grafts in CABG”, “arterial grafts in CABG”, “radial artery grafts in CABG”, “gastroepiploic artery grafts in CABG”, “patency and clinical outcomes”. Inclusion criteria included: RCTs comparing the long-term patency, and clinical outcomes of radial artery, right internal thoracic artery, gastroduodenal artery, and saphenous vein grafts used in CABG. Long-term patency of the grafts and clinical outcomes were analyzed.ResultsEight RCTs involving 2,091 patients with 1,164 patients receiving arterial grafts and 927 patients receiving venous grafts were included. There was no difference between the long-term patency rate (relative risk (RR) = 1.050, 95% confidence interval (CI) = 0.949 to 1.162, and p = 0.344), overall mortality rate (RR = 1.095, 95% CI = 0.561 to 2.136, and p = 0.790), rate of myocardial infarction (MI) (RR = 0.860, 95% CI = 0.409 to 1.812, and P = 0.692), and re-intervention rate (RR = 0.0768, 95% CI = 0.419 to 1.406, and P = 0.392) between arterial and venous grafts.ConclusionThe use of arterial conduits over the venous conduits has no significant superiority regarding the long-term graft patency, the rate of MI, overall mortality, and the rate of revascularization following CABG. Additional adequately powered studies are needed to further evaluate the long-term outcomes of arterial and venous grafts following the CABG.

Endoscopic vein harvesting

“…Whereas the LIMA-LAD graft is thought to be singularly responsible for improved life expectancy following coronary artery bypass grafting, the effects of occluded grafts elsewhere on the heart is less clear. Few studies have examined the long-term clinical outcomes such as mortality, repeat revascularisation or symptom recurrence associated with graft occlusion, and systematic review indicates that the data is heterogenous and difficult to aggregate (59). The clinical effects of failing saphenous vein grafts in the context of patent LIMA-LAD, therefore, are difficult to know: studies may have been underpowered to detect small differences and many did not include angina recurrence as a late outcome.…”

Isolated Antineutrophil Cytoplasmic Antibody-Associated Coronary Vasculitis and Valvulitis

“…Currently, there are no guidelines for revascularization strategies of coronary AAV. The role of percutaneous coronary intervention is unclear, with recent literature suggesting common restenosis in endovascular therapy in large vessel vasculitides ( 9 , 10 ). Our patient’s critical left main disease required CABG.…”

Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization

“…Отдаленный прогноз после КШ критически зависит оттого, как долго сохраняется адекватная проходимость шунтов. Известно, что через 10-20 лет после вмешательства проходимы -около 90% артериальных и 40-50% венозных шунтов [36]. Показатели 10-летней выживаемости варьировали от 91% при использовании только маммарных до 62,3% -только венозных шунтов, соответственно [37].…”