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Published on: March 27, 2018
Angiographic Patency of Coronary Artery Bypass Conduits: A Network Meta-Analysis of Randomized Trials
Mario Gaudino1, Irbaz Hameed1, N Bryce Robinson1
1Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY.
Insights
The radial artery (RA) and no-touch saphenous vein show significantly lower graft occlusion after coronary bypass surgery compared to conventional saphenous vein grafts. The RA is identified as the superior conduit for improved patency rates.
Area of Science:
- Cardiovascular Surgery
- Medical Research
- Evidence-Based Medicine
Background:
- Previous studies on coronary artery bypass conduits used pairwise comparisons.
- A comprehensive evaluation of all conduit patency rates from randomized trials was lacking.
Purpose of the Study:
- To investigate angiographic patency rates of all coronary bypass conduits.
- To perform a network meta-analysis of available randomized evidence.
Main Methods:
- Systematic literature search for randomized controlled trials.
- Included trials compared conventionally harvested saphenous vein, no-touch saphenous vein, radial artery (RA), right internal thoracic artery, or gastroepiploic artery.
- Primary outcome was graft occlusion, with a weighted mean angiographic follow-up of 5.1 years.
Main Results:
- 14 trials with 3651 grafts analyzed.
- RA (IRR 0.54) and no-touch saphenous vein (IRR 0.55) showed lower graft occlusion versus conventionally harvested saphenous vein.
- RA ranked highest (0.87) followed by no-touch saphenous vein (0.85).
Conclusions:
- RA and no-touch saphenous vein grafts have significantly lower occlusion rates than conventional saphenous vein grafts.
- The radial artery is the best-performing conduit for coronary bypass surgery.
Abstract:
Background Several randomized trials have compared the patency of coronary artery bypass conduits. All of the published studies, however, have performed pairwise comparisons and a comprehensive evaluation of the patency rates of all conduits has yet to be published. We set out to investigate the angiographic patency rates of all conduits used in coronary bypass surgery by performing a network meta-analysis of the current available randomized evidence. Methods and Results A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency rate of the conventionally harvested saphenous vein, the no-touch saphenous vein, the radial artery (RA), the right internal thoracic artery, or the gastroepiploic artery. The primary outcome was graft occlusion. A total of 4160 studies were retrieved of which 14 were included with 3651 grafts analyzed. The weighted mean angiographic follow-up was 5.1 years. Compared with the conventionally harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54; 95% CI, 0.35-0.82) and the no-touch saphenous vein (IRR 0.55; 95% CI, 0.39-0.78) were associated with lower graft occlusion. The RA ranked as the best conduit (rank score for RA 0.87 versus 0.85 for no-touch saphenous vein, 0.23 for right internal thoracic artery, 0.29 for gastroepiploic artery, and 0.25 for the conventionally harvested saphenous vein). Conclusions Compared with the conventionally harvested saphenous vein, only the RA and no-touch saphenous vein grafts are associated with significantly lower graft occlusion rates. The RA ranks as the best conduit. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020164492.
