Coronary Artery Bypass Surgery Without Saphenous Vein Grafting: JACC Review Topic of the Week

Alistair Royse, Justin Ren, Colin Royse, David H. Tian, Stephen Fremes, Mario Gaudino, Umberto Benedetto, Y. Joseph Woo, Andrew B. Goldstone, Piroze Davierwala, Michael Borger, Michael Vallely, Christopher M. Reid, Rodolfo Rocha, David Glineur, Juan Grau, Richard Shaw, Hugh Paterson, Doa El-Ansary, Stuart BoggettNilesh Srivastav, Zulfayandi Pawanis, David Canty, Rinaldo Bellomo

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)

Abstract

Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N = 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77; 95% CI: 0.71-0.84; P < 0.001). An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565). It found reduced all-cause mortality for TAR (HR: 0.78; 95% CI: 0.72-0.85; P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality.

Original languageEnglish
Pages (from-to)1833-1843
Number of pages11
JournalJournal of the American College of Cardiology
Volume80
Issue number19
DOIs
Publication statusPublished - 8 Nov 2022

Keywords

  • CABG
  • SVG
  • TAR
  • meta-analysis
  • mortality
  • total arterial revascularization

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