Patency of Individual and Sequential Coronary Artery Bypass in Patients with Ischemic Heart Disease: A Meta-analysis

Li, Zeshu; Liu, Luqi

doi:10.21470/1678-9741-2018-0284

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Brazilian Journal of Cardiovascular Surgery

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Sumário

ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 34 (04) • Jul-Aug 2019 • https://doi.org/10.21470/1678-9741-2018-0284 copy

Patency of Individual and Sequential Coronary Artery Bypass in Patients with Ischemic Heart Disease: A Meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease.

Methods:

We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data.

Results:

Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I²=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I²=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I²=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I²=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I²=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I²=0%).

Conclusion:

No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.

Keywords:
Coronary Artery Bypass; Coronary Artery Disease; Myocardial Ischemia; Hospital Mortality; Meta-Analysis as Topic

Abbreviations, acronyms & symbols
CABG	= Coronary artery bypass grafting	PDA	= Posterior descending artery
CIs	= Confidence intervals	PRISMA	= Preferred Reporting Items for Systematic Review and Meta-analysis
Cl	= Control	RCA	= Right coronary artery
CT	= Computed tomography	RRs	= Risk ratios
EMBASE	= Excerpta Medica database	SMD	= Standardized mean difference
LAD	= Left anterior descending
NOS	= Newcastle Ottawa Scale

References	Community	Comparability			Assessment method	Follow-up time	Quality assessment (NOS)
References	Community	Age	Male (%)	Other factors	Assessment method	Follow-up time	Rate (%)	Selection	Comparability	Outcome	Total
Takazawa et al.^[¹³13 Takazawa A, Nakajima H, Iguchi A, Tabata M, Morita K, Koike H, et al. Impacts of intraoperative flow on graft patency of sequential and individual saphenous vein grafts. Innovations (Phila). 2015;10(2):85-9. doi:10.1097/IMI.0000000000000140. https://doi.org/10.1097/IMI.000000000000... ^], 2015	Saitama International Medical Center in Japan	71±8	63.4	_	Angiography	14.7±17.5	_	4	1	2	7
Fukui et al.^[⁸8 Fukui T, Tabata M, Morita S, Takanashi S. Sequential free right internal thoracic artery grafting for multivessel coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012;144(4):824-9. doi:10.1016/j.jtcvs.2011.11.021. https://doi.org/10.1016/j.jtcvs.2011.11.... ^], 2012	Sakakibara Heart Institute, Tokyo, Japan	67.2±10.4/67.0±10.7	76.5/85.2	Body surface area	Angiography	12.1(221)	50.9	4	2	1	7
Samano et al.^[¹²12 Samano N, Geijer H, Bodin L, Arbeus M, Mannion JD, Dashwood M, et al. The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery. J Thorac Cardiovasc Surg. 2017 Aug;154(2):457-466.e3. doi:10.1016/j.jtcvs.2017.03.048. https://doi.org/10.1016/j.jtcvs.2017.03.... ^], 2017	Orebro University Hospital, rebro, Sweden.	75.6±8.5	74.6/81	Body mass index, hypertension	Angiography	72	93.8	4	2	3	9
Ji et al.^[¹⁰10 Ji Q, Shi Y, Xia L, Ma R, Shen J, Lai H, et al. Revascularization of Left Coronary System Using a Skeletonized Left Internal Mammary Artery - Sequential vs. Separate Grafting. Circ J. 2017;82(1):102-9. doi:10.1253/circj.CJ-17-0223. https://doi.org/10.1253/circj.CJ-17-0223... ^], 2017	Zhongshan Hospital Fudan University, China	63.6±8.5/62.9±9.4	87.5/90	Smoking history, diabetes mellitus	Computed tomographic angiography	27.0±7.3	_	4	2	2	9
Gao et al.^[⁹9 Gao C, Wang M, Wang G, Xiao C, Wu Y, Li B, et al. Patency of sequential and individual saphenous vein grafts after off-pump coronary artery bypass grafting. J Card Surg. 2010;25(6):633-7. doi:10.1111/j.1540-8191.2010.01145.x. https://doi.org/10.1111/j.1540-8191.2010... ^], 2010	Patients operated on by a single surgeon	63.6±10.3	89	_	Angiography	26.4±23.6	_	4	2	1	7
Kim et al.^[¹¹11 Kim HJ, Lee TY, Kim JB, Cho WC, Jung SH, Chung CH, et al. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. J Thorac Cardiovasc Surg. 2011 Mar;141(3):750-4. doi:10.1016/j.jtcvs.2010.05.037. https://doi.org/10.1016/j.jtcvs.2010.05.... ^], 2011	Asan Medical Center	63.7±8.3/62.9±8.3	69.6/69	Hypertension, diabetes mellitus	Dual-source CT	14.8	_	4	2	2	8
Farsak et al.^[⁷7 Farsak B, Tokmakoglu H, Kandemir O, Günaydin S, Aydin H, Yorgancioglu C, et al. Angiographic assessment of sequential and individual coronary artery bypass grafting. J Card Surg. 2003;18(6):524-9; discussion 30-31. doi:10.1046/j.0886-0440.2003.02063.x. https://doi.org/10.1046/j.0886-0440.2003... ^], 2003	_	55.2±9.3	87	Atherosclerotic risk factors	Angiography	55.4±17.6	_	3	2	2	7
Vural et al.^[¹⁴14 Vural KM, Sener E, Tasdemir O. Long-term patency of sequential and individual saphenous vein coronary bypass grafts. Eur J Cardiothorac Surg. 2001;19(2):140-4. doi:10.1016/S1010-7940(00)00629-1. https://doi.org/10.1016/S1010-7940(00)00... ^], 2001	Yuksek Ihtisas Hospital in Turkey	49±8	89	Atherosclerotic risk factors	Angiography	69.6	_	4	2	2	8
Christenson et al.^[⁶6 Christenson JT, Simonet F, Schmuziger M. Sequential vein bypass grafting: tactics and long-term results. Cardiovasc Surg. 1998;6(4):389-97. doi:10.1016/S0967-2109(98)00024-6. https://doi.org/10.1016/S0967-2109(98)00... ^], 1998	_	58.2±9.2	81	Hypertension, hyperlipidemia, diabetes	Angiography	76	99.10%	3	2	3	8

Endpoints	P-value
Graft patency	1.00
Anastomosis patency	0.133
Occluded rate in LAD system	0.296
Occluded rate in RCA system	0.296
In-hospital mortality	0.296

Authors' roles & responsibilities
ZL	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
LL	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published

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[1] Correspondence Address: Luqi Liu, https://orcid.org/0000-0002-5185-7608, Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, Shandong, People's Republic of China. Zip Code: 250014. Email: luqizh@yeah.net