Aortocoronary Versus Composite Grafting Strategies in Coronary Artery Bypass Surgery: a Network Meta-analysis

Coronary artery bypass graft surgery (CABG) has traditionally used an in situ left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD), in addition to aortocoronary anastomoses to graft non-LAD target vessels. Composite grafting provides an opportunity to avoid aortic anastomoses by using nonaortic anastomoses to provide greater efficiency in the use of conduits for improved all-cause mortality and reduced aortic manipulation to lower the incidence of postoperative stroke. In this study we performed a network meta-analysis (NMA) to compare aortocoronary and various composite grafting strategies for CABG. A systematic search of 6 electronic databases identified all publications reporting outcomes of CABG with aortocoronary or composite grafting strategies. The primary outcome was in-hospital or 30-day all-cause mortality, and studies that reported these were included in our NMA. The study protocol was registered with PROSPERO (CRD42023402665) and conformed with PRISMA 2020 and MOOSE guidelines. A systematic search of 6 electronic databases identified all publications reporting outcomes of the included operations. A total of 6656 articles were screened, 24 of which (8 RCTs and 16 observational studies) were included with a total of 9692 patients. There was no difference in conventional aortocoronary anastomosis and composite grafting for the outcome of in-hospital or 30-day all-cause mortality (P = 0.387). There was also no difference in rates of stroke (P = 0.277), myocardial infarction (P = 0.09), reoperation for bleeding (P = 0.500), postoperative atrial fibrillation (P = 0.219), and deep sternal wound infection (P = 0.549). This Bayesian NMA of 9692 patients demonstrated that composite grafting CABG can be performed as safely as conventional aortocoronary CABG. PROSPERO REGISTRATION: CRD42023402665.