Sérgio C Rayol1,2, Jef Van den Eynde3, Luiz Rafael P Cavalcanti1,2, Antonio Carlos Escorel1,2, Arian Arjomandi Rad4, Andrea Amabile5, Wilson Botelho6, Arjang Ruhparwar7, Konstantin Zhigalov7, Alexander Weymann7, Dario Celestino Sobral2, Michel Pompeu B O Sá1,2. 1. Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil. 2. University of Pernambuco - UPE, Recife, Pernambuco, Brazil. 3. Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium. 4. Imperial College London School of Medicine, London, England. 5. Department of Cardiac Surgery, University of Chicago Medicine, Chicago, United States of America. 6. Instituto do Coração - InCor, Universidade de São Paulo - USP, São Paulo, São Paulo, Brazil. 7. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
Abstract
INTRODUCTION: The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. METHODS: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. RESULTS: Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome. CONCLUSION: This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.
INTRODUCTION: The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. METHODS: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. RESULTS: Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome. CONCLUSION: This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.
Authors: Rodolfo V Rocha; Derrick Y Tam; Reena Karkhanis; Xuesong Wang; Peter C Austin; Dennis T Ko; Mario Gaudino; Alistair Royse; Stephen E Fremes Journal: JAMA Cardiol Date: 2020-05-01 Impact factor: 14.676
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Authors: Hersh S Maniar; Hendrick B Barner; Marci S Bailey; Sunil M Prasad; Marc R Moon; Michael K Pasque; Martha L Lester; William A Gay; Ralph J Damiano Journal: Ann Thorac Surg Date: 2003-11 Impact factor: 4.330