Christopher Cao1, Su C Ang, Kevin Wolak, Sheen Peeceeyen, Paul Bannon, Tristan D Yan. 1. The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia;
Abstract
BACKGROUND: Currently, saphenous vein (SV) and radial artery (RA) are the most commonly used conduits in combination with the left internal mammary artery for conventional coronary artery bypass graft surgery (CABG). The present meta-analysis aimed to assess the existing evidence from randomized controlled trials (RCTs) to compare the angiographic outcomes of these two conduits at mid-term follow-up. METHODS: Four relevant and updated RCTs with follow-up beyond 3 years were identified using five electronic databases. Angiographic endpoints included complete occlusion, 'string sign', graft failure and complete patency. RESULTS: The incidence of complete occlusion was significantly lower after using RA compared to SV [6.7% vs. 17.2%; odd ratio (OR), 0.36; 95% confidence interval (CI), 0.23-0.58; P<0.0001]. The angiographic 'string sign' was significantly more likely to be identified after using RA compared to SV (3.1% vs. 0%; OR, 5.65; 95% CI, 1.21-26.39; P=0.03). Graft failure was significantly lower after RA compared to SV (9.6% vs. 18.8%; OR, 0.47; 95% CI, 0.30-0.72; P=0.0005). Complete graft patency was found to be significantly higher after RA compared to SV (88.6% vs. 75.8%; OR, 3.19; 95% CI, 1.42-7.16; P=0.005). CONCLUSIONS: Results of the present meta-analysis suggest that selected patients with severe, proximal stenosis may have superior angiographic outcomes at mid-term follow-up after using RA compared to SV for CABG. However, RA is associated with a significantly higher incidence of the 'string sign'. Future studies should aim to collect additional data on symptomatic outcomes.
BACKGROUND: Currently, saphenous vein (SV) and radial artery (RA) are the most commonly used conduits in combination with the left internal mammary artery for conventional coronary artery bypass graft surgery (CABG). The present meta-analysis aimed to assess the existing evidence from randomized controlled trials (RCTs) to compare the angiographic outcomes of these two conduits at mid-term follow-up. METHODS: Four relevant and updated RCTs with follow-up beyond 3 years were identified using five electronic databases. Angiographic endpoints included complete occlusion, 'string sign', graft failure and complete patency. RESULTS: The incidence of complete occlusion was significantly lower after using RA compared to SV [6.7% vs. 17.2%; odd ratio (OR), 0.36; 95% confidence interval (CI), 0.23-0.58; P<0.0001]. The angiographic 'string sign' was significantly more likely to be identified after using RA compared to SV (3.1% vs. 0%; OR, 5.65; 95% CI, 1.21-26.39; P=0.03). Graft failure was significantly lower after RA compared to SV (9.6% vs. 18.8%; OR, 0.47; 95% CI, 0.30-0.72; P=0.0005). Complete graft patency was found to be significantly higher after RA compared to SV (88.6% vs. 75.8%; OR, 3.19; 95% CI, 1.42-7.16; P=0.005). CONCLUSIONS: Results of the present meta-analysis suggest that selected patients with severe, proximal stenosis may have superior angiographic outcomes at mid-term follow-up after using RA compared to SV for CABG. However, RA is associated with a significantly higher incidence of the 'string sign'. Future studies should aim to collect additional data on symptomatic outcomes.
Authors: Christopher Cao; Con Manganas; Paul Bannon; Michael Vallely; Tristan D Yan Journal: J Thorac Cardiovasc Surg Date: 2012-03-09 Impact factor: 5.209
Authors: Friedrich W Mohr; Marie-Claude Morice; A Pieter Kappetein; Ted E Feldman; Elisabeth Ståhle; Antonio Colombo; Michael J Mack; David R Holmes; Marie-angèle Morel; Nic Van Dyck; Vicki M Houle; Keith D Dawkins; Patrick W Serruys Journal: Lancet Date: 2013-02-23 Impact factor: 79.321
Authors: Steven Goldman; Gulshan K Sethi; William Holman; Hoang Thai; Edward McFalls; Herbert B Ward; Rosemary F Kelly; Birger Rhenman; Gareth H Tobler; Faisal G Bakaeen; Joseph Huh; Ernesto Soltero; Mohammed Moursi; Miguel Haime; Michael Crittenden; Vigneshwar Kasirajan; Michelle Ratliff; Stewart Pett; Anand Irimpen; William Gunnar; Donald Thomas; Stephen Fremes; Thomas Moritz; Domenic Reda; Lynn Harrison; Todd H Wagner; Yajie Wang; Lori Planting; Meredith Miller; Yvette Rodriguez; Elizabeth Juneman; Douglass Morrison; Mary Kaye Pierce; Sandra Kreamer; Mei-Chiung Shih; Kelvin Lee Journal: JAMA Date: 2011-01-12 Impact factor: 56.272
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: A J Acinapura; I J Jacobowitz; M D Kramer; Z Zisbrod; J N Cunningham Journal: J Cardiovasc Surg (Torino) Date: 1992 Sep-Oct Impact factor: 1.888
Authors: Matthew M Y Lee; Mark C Petrie; Paul Rocchiccioli; Joanne Simpson; Colette Jackson; Ammani Brown; David Corcoran; Kenneth Mangion; Margaret McEntegart; Aadil Shaukat; Alan Rae; Stuart Hood; Eileen Peat; Iain Findlay; Clare Murphy; Alistair Cormack; Nikolay Bukov; Kanarath Balachandran; Richard Papworth; Ian Ford; Andrew Briggs; Colin Berry Journal: Open Heart Date: 2016-04-20