Zhuoming Zhou1,2, Guangguo Fu1,2, Suiqing Huang1,2, Sida Chen1,2, Mengya Liang1,2, Zhongkai Wu1,2. 1. Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. 2. NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Abstract
AIMS: Whether bilateral internal thoracic artery (BITA) grafting benefits elderly patients in coronary artery bypass grafting (CABG) remains unclear since they tend to have a limited life expectancy and severe comorbidities. We aim to evaluate the outcomes of BITA versus single internal thoracic artery (SITA) grafting in elderly patients. METHODS AND RESULTS: A meta-analysis was performed by database searching until May 2021. Studies comparing BITA and SITA grafting among elderly patients were included. One randomized controlled trial, nine propensity score matching and six unmatched studies were identified, with a total of 18,146 patients (7,422 received BITA, and 10,724 received SITA). Compared with SITA, BITA grafting had a higher risk of deep sternal wound infection (DSWI) (OR: 1.67; 95% CI, 1.22-2.28), and this risk could not be significantly reduced by skeletonized technique. Meanwhile, BITA grafting was associated with a higher long-term survival (HR: 0.83; 95% CI, 0.77-0.90), except for the octogenarian subgroup. Reconstructed Kaplan-Meier survival curves revealed 4-year, 8-year and 12-year overall survival rates of 85.5%, 66.7%, and 45.3%, respectively, in the BITA group and 79.3%, 58.6%, and 34.9%, respectively, in the SITA group. No significant difference was observed in early mortality, perioperative myocardial infarction, perioperative cerebral vascular accidents or re-exploration for bleeding. CONCLUSIONS: Compared with SITA, BITA grafting could provide a long-term survival benefit for elderly patients, though this benefit remained uncertain in octogenarians. Meanwhile, elderly patients recieved BITA were associated with a higher risk of DSWI and such a risk could not be eliminated by the skeletonized technique.
AIMS: Whether bilateral internal thoracic artery (BITA) grafting benefits elderly patients in coronary artery bypass grafting (CABG) remains unclear since they tend to have a limited life expectancy and severe comorbidities. We aim to evaluate the outcomes of BITA versus single internal thoracic artery (SITA) grafting in elderly patients. METHODS AND RESULTS: A meta-analysis was performed by database searching until May 2021. Studies comparing BITA and SITA grafting among elderly patients were included. One randomized controlled trial, nine propensity score matching and six unmatched studies were identified, with a total of 18,146 patients (7,422 received BITA, and 10,724 received SITA). Compared with SITA, BITA grafting had a higher risk of deep sternal wound infection (DSWI) (OR: 1.67; 95% CI, 1.22-2.28), and this risk could not be significantly reduced by skeletonized technique. Meanwhile, BITA grafting was associated with a higher long-term survival (HR: 0.83; 95% CI, 0.77-0.90), except for the octogenarian subgroup. Reconstructed Kaplan-Meier survival curves revealed 4-year, 8-year and 12-year overall survival rates of 85.5%, 66.7%, and 45.3%, respectively, in the BITA group and 79.3%, 58.6%, and 34.9%, respectively, in the SITA group. No significant difference was observed in early mortality, perioperative myocardial infarction, perioperative cerebral vascular accidents or re-exploration for bleeding. CONCLUSIONS: Compared with SITA, BITA grafting could provide a long-term survival benefit for elderly patients, though this benefit remained uncertain in octogenarians. Meanwhile, elderly patients recieved BITA were associated with a higher risk of DSWI and such a risk could not be eliminated by the skeletonized technique.