Umberto Benedetto1, Mario Gaudino2, Massimo Caputo3, Robert F Tranbaugh2, Christopher Lau2, Antonino Di Franco2, Colin Ng4, Leonard N Girardi2, Gianni D Angelini3. 1. Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. Electronic address: umberto.benedetto@bristol.ac.uk. 2. Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY. 3. Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. 4. National University of Singapore, Singapore.
Abstract
OBJECTIVE(S): We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (RITA) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting. METHODS: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method. RESULTS: A total of 8 PSM studies were finally selected including 15,374 patients (RITA, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, RITA was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, RITA did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). CONCLUSIONS: The present PSM data meta-analysis suggests that the use of RITA compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.
OBJECTIVE(S): We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (RITA) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting. METHODS: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method. RESULTS: A total of 8 PSM studies were finally selected including 15,374 patients (RITA, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, RITA was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, RITA did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). CONCLUSIONS: The present PSM data meta-analysis suggests that the use of RITA compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.
Authors: Adam S Evans; Menachem M Weiner; Shahzad Shaefi; Prakash A Patel; Matthew M Townsley; Abirami Kumaresan; Jared W Feinman; Ashley V Fritz; Archer K Martin; Toby B Steinberg; J Ross Renew; Jane L Gui; Brian Radvansky; Himani Bhatt; Sudhakar Subramani; Archit Sharma; Jacob T Gutsche; John G Augoustides; Harish Ramakrishna Journal: J Cardiothorac Vasc Anesth Date: 2019-11-09 Impact factor: 2.628
Authors: Mario Gaudino; Roberto Lorusso; Mohamed Rahouma; Ahmed Abouarab; Derrick Y Tam; Cristiano Spadaccio; Gaëlle Saint-Hilary; Jeremy Leonard; Mario Iannaccone; Fabrizio D'Ascenzo; Antonino Di Franco; Giovanni Soletti; Mohamed K Kamel; Christopher Lau; Leonard N Girardi; Thomas A Schwann; Umberto Benedetto; David P Taggart; Stephen E Fremes Journal: J Am Heart Assoc Date: 2019-01-22 Impact factor: 5.501