Bayesian Network Meta-Analysis of Long-Term Survival: Single vs Multiple vs Total Arterial Coronary Bypass Grafting

Arterial conduit strategies in coronary artery bypass grafting (CABG) have been associated with superior graft durability to saphenous vein grafts. However, the relative benefits of multiple arterial grafting (MAG) and total arterial revascularization (TAR) remain uncertain due to limited direct comparative evidence.

This systematic review and Bayesian network meta-analysis (PROSPERO; CRD420251117898) evaluated long-term survival outcomes associated with single arterial grafting (SAG), MAG, and TAR.

Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and the Cochrane Library were searched from inception to March 2026 for studies comparing CABG conduit strategies reporting adjusted HRs for long-term all-cause mortality. Studies including adults undergoing isolated CABG with SAG, MAG, or TAR were eligible. A Bayesian random-effects network meta-analysis was performed to integrate direct and indirect evidence. This framework permitted quantification of TAR-versus MAG comparisons, which had previously been limited by scarce direct evidence. Treatment ranking was assessed using the surface under the cumulative ranking curve.

Fifty-four studies including 560,723 patients were analyzed. Compared with SAG, MAG was associated with lower long-term mortality (HR: 0.83; 95% credible interval [CrI]: 0.79-0.85), whereas TAR demonstrated a greater survival benefit (HR: 0.75; 95% CrI: 0.70-0.79). Indirect comparison within the network suggested an incremental survival advantage of TAR over MAG (HR: 0.90; 95% CrI: 0.85-0.96). Treatment ranking suggested a hierarchy in which TAR was associated with superior survival, followed by MAG and SAG.

Increasing use of arterial conduits during CABG is associated with progressively improved long-term survival, with TAR demonstrating the greatest benefit.