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 Boggett; Nilesh Srivastav; Zulfayandi Pawanis; David Canty; Rinaldo Bellomo

doi:10.1016/j.jacc.2022.08.795

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

J Am Coll Cardiol. 2022 Nov 8;80(19):1833-1843. doi: 10.1016/j.jacc.2022.08.795.

Authors

Alistair Royse¹, Justin Ren², Colin Royse³, David H Tian⁴, Stephen Fremes⁵, Mario Gaudino⁶, Umberto Benedetto⁷, Y Joseph Woo⁸, Andrew B Goldstone⁹, Piroze Davierwala¹⁰, Michael Borger¹¹, Michael Vallely¹², Christopher M Reid¹³, Rodolfo Rocha⁵, David Glineur¹⁴, Juan Grau¹⁵, Richard Shaw¹⁶, Hugh Paterson¹⁷, Doa El-Ansary¹⁸, Stuart Boggett², Nilesh Srivastav², Zulfayandi Pawanis¹⁹, David Canty², Rinaldo Bellomo²⁰

Affiliations

¹ Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Alistair.Royse@iteachu.com.
² Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
³ Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia; Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Department of Anesthesia, Westmead Hospital, Sydney, New South Wales, Australia.
⁵ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Surgery, Weill Cornell Medicine, New York, New York, USA.
⁷ Universita degli Studi G. d'Annunzio, Chieti-Pescara, Italy.
⁸ Surgery, Stanford University, San Francisco, California, USA.
⁹ Department of Surgery, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
¹⁰ Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
¹¹ Department of Surgery, University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
¹² Department of Surgery, Ohio State University, Columbus, Ohio, USA.
¹³ Department of Epidemiology, Curtin University, Perth, Western Australia, Australia.
¹⁴ Department of Surgery, Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Surgery, Clinique St Luc Bouge, Bouge, Belgium.
¹⁵ Department of Surgery, Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹⁶ Department of Surgery, Valley Health, Ridgewood, New Jersey, USA.
¹⁷ Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Swinburn University, Melbourne, Victoria, Australia.
¹⁹ Department of Surgery, Universitas Airlangga, Surabaya, Indonesia.
²⁰ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 36328694
DOI: 10.1016/j.jacc.2022.08.795

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.

Keywords: CABG; SVG; TAR; meta-analysis; mortality; total arterial revascularization.

Publication types

Review

MeSH terms

Arteries
Bayes Theorem
Coronary Artery Bypass* / methods
Humans
Saphenous Vein* / transplantation
Treatment Outcome