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

Abstract

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.

Sternal wound infections following internal mammary artery grafts for a coronary bypass: A meta‐analysis

“…Additionally, the type of sternal wound infection did not affect the chance of developing it. After a single internal mammary artery procedure, a significant risk reduction was shown in several other meta‐analyses that focused on either superficial or deep sternal wound infections, for example, severe wound healing disorder or mediastinitis 39–44 . Age, body mass index (BMI), ejection fraction, gender, diabetes mellitus, smoking, peripheral arterial occlusive disease and chronic renal insufficiency were the key factors separating the populations in these examinations with a single internal mammary artery and those with bilateral internal mammary arterys 8,9,12,14,17 .…”

“…After a single internal mammary artery procedure, a significant risk reduction was shown in several other meta-analyses that focused on either superficial or deep sternal wound infections, for example, severe wound healing disorder or mediastinitis. [39][40][41][42][43][44] Age, body mass index (BMI), ejection fraction, gender, diabetes mellitus, smoking, peripheral arterial occlusive disease and chronic renal insufficiency were the key factors separating the populations in these examinations with a single F I G U R E 7 The effect's forest plot of the bilateral internal mammary artery compared to single internal mammary artery on sternal wound infection in pedicled preparation in personals with coronary artery bypass grafting.…”

“…After a single internal mammary artery procedure, a significant risk reduction was shown in several other meta‐analyses that focused on either superficial or deep sternal wound infections, for example, severe wound healing disorder or mediastinitis. 39 , 40 , 41 , 42 , 43 , 44 Age, body mass index (BMI), ejection fraction, gender, diabetes mellitus, smoking, peripheral arterial occlusive disease and chronic renal insufficiency were the key factors separating the populations in these examinations with a single internal mammary artery and those with bilateral internal mammary arterys. 8 , 9 , 12 , 14 , 17 The fact that there were fewer significant differences between the two groups in non‐randomized and non‐matched examinations as compared to matched or randomized examinations may be due to the enclosure of more high‐risk personals in the single internal mammary artery groups as opposed to the bilateral internal mammary artery groups.…”

Impact of Post-Operative Infection after CABG on Long-Term Survival

“…One study based on data from the SWEDEHEART registry showed that of the 37,520 patients who underwent first-time CABG surgery in Sweden between 2006 and 2017, 2.8% (1057) did not survive the first 6 months after surgery [3]. A 2022 meta-analysis based on data from 180,459 patients undergoing CABG showed that the median overall survival of patients undergoing CABG with multiple arterial grafting was 17.54 years, whereas the median overall survival of patients undergoing CABG with single arterial grafting was 11.63 years [4]. It should be noted that a number of perioperative factors may affect short-and long-term prognosis and survival in patients undergoing CABG.…”

Surgery and Reason: The End of History and the Last Surgeon

“…Based on increasing evidence favoring the use of multiple arterial conduits in patients undergoing CABG [11], a "Hegelian" circle, based on the superiority of the MAG approach, is about to close, and a new one is about to open, which will examine different strategies in conduits harvesting, treatment protocols on the extent of target vessel stenosis for radial artery conduits, along with post-discharge treatment protocols.…”