Total arterial revascularization is associated with long-term survival benefit in coronary artery bypass grafting: systematic review with meta-analysis

Abstract Importance Total arterial revascularization (TAR), the complete avoidance of saphenous vein grafting (SVG) in coronary artery bypass (CABG), is advocated based on superior conduit durability and resistance against atherosclerosis. However, low adoption rate TAR indicates a high level controversy. Objective To compare long-term survival between conventional CABG involving SVG. Data sources A comprehensive literature search was conducted through digital databases including MEDLINE, Embase, Cochrane Central Register Controlled Trials from inception to May 2021. Study selection The inclusion criteria were randomized clinical trials, or propensity-score balanced multivariable-adjusted observational studies with sample size at least 100 patients each arm, isolated CABG, comparing (SVG=0) vs. non-TAR (SVG≥1), all-cause mortality. extraction synthesis Two reviewers performed independent following Preferred Reporting Items for Systematic Reviews Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) 95% confidence intervals (CI) estimated random-effect fixed-effect models using generic inverse variance weighting. Individual patient time-to-event data reconstructed create an overall Kaplan-Meier function matched studies. Sensitivity analyses according risk bias, matching status, source HR. Main outcomes measures primary endpoint Results total 23 (100,314 patients), all retrospective design, identified. weighted mean follow-up time 8.8 years post-operatively. associated greater freedom mortality than (HR, 0.77, CI, 0.71 0.84, p<0.001). There evidence heterogeneity (I2=45%) across Low publication bias observed. Leave-one-out influence analysis sensitivity produced consistent results. Collaboration signaling domains showed no critical bias. Conclusions relevance This meta-analysis found late revascularization. Further trials are needed. Funding Acknowledgement Type funding sources: None.