BACKGROUND: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival. METHODS: Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies. RESULTS: No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001]. CONCLUSIONS: In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.
BACKGROUND: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival. METHODS: Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies. RESULTS: No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001]. CONCLUSIONS: In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.
Authors: David Glineur; William D'hoore; Joel Price; Sarah Dorméus; Laurent de Kerchove; Robert Dion; Philippe Noirhomme; Gebrine El Khoury Journal: Eur J Cardiothorac Surg Date: 2012-01-26 Impact factor: 4.191
Authors: Bruce W Lytle; Eugene H Blackstone; Joseph F Sabik; Penny Houghtaling; Floyd D Loop; Delos M Cosgrove Journal: Ann Thorac Surg Date: 2004-12 Impact factor: 4.330
Authors: John D Puskas; Adil Sadiq; Thomas A Vassiliades; Patrick D Kilgo; Omar M Lattouf Journal: Ann Thorac Surg Date: 2012-06-06 Impact factor: 4.330
Authors: L R Dewar; W R Jamieson; M T Janusz; M Adeli-Sardo; E Germann; J S MacNab; G F Tyers Journal: Circulation Date: 1995-11-01 Impact factor: 29.690