REVIEW  CARDIAC SECTION Free access

The Journal of Cardiovascular Surgery 2022 April;63(2):169-78

DOI: 10.23736/S0021-9509.21.11826-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Multiple versus single arterial grafting in the elderly: a meta-analysis of randomized controlled trials and propensity score studies

Francisca A. SARAIVA ¹, Raquel MOREIRA ¹, Rui J. CERQUEIRA ^{1, 2}, Jennifer MANCIO ^{1, 3}, António S. BARROS ¹, André P. LOURENÇO ^{1, 4}, Adelino F. LEITE-MOREIRA ^{1, 2} ✉

¹ Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal; ² Department of Cardiothoracic Surgery, São João University Hospital, Porto, Portugal; ³ St. Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK; ⁴ Department of Anesthesiology, São João University Hospital, Porto, Portugal

INTRODUCTION: The benefit of adding a second arterial conduit is still controversial, mainly in specific subgroups. We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and early results in elderly patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG).
EVIDENCE ACQUISITION: MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a ≥1-year follow-up and early outcomes were evaluated. Outcomes were collected from matched samples or PS adjusted analysis: hazard ratio (HR) along with their variance, frequencies or odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events).
EVIDENCE SYNTHESIS: Eleven PS cohorts and 1 RCT comprising >18,800 patients older than 70 (>6200 MAG and >12,500 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.81, 95% CI: 0.72-0.91, P<0.01, I²=64%) in the absence of higher risk of early mortality (pooled OR: 0.74, 95% CI: 0.44 to 1.25, P=0.27, I²=0%). In a meta-regression, MAG survival advantage was more pronounced in studies with a higher MAG usage rate (β=-0.0052, P=0.021).
CONCLUSIONS: Current evidence suggests that advanced age should not limit MAG’s use considering its benefits in long-term survival. Of note, an individualized patient selection for this approach is warranted.

KEY WORDS: Coronary artery bypass; Aged; Internal mammary-coronary artery anastomosis; Survival