Right internal thoracic artery versus radial artery as the second best arterial conduit. Insights from a meta-analysis of propensity-matched data on long term survival

Umberto Benedetto, Mario Gaudino, Massimo Caputo, Robert F. Tranbaugh, Christopher Lau, Antonino Di Franco, Colin Ng, Leonard N. Girardi, Gianni D. Angelini

Research output: Contribution to journalArticle (Academic Journal)

22 Citations (Scopus)
211 Downloads (Pure)

Abstract

Objective(s)

We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (RITA) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting.

Methods

A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method.

Results

A total of 8 PSM studies were finally selected including 15,374 patients (RITA, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, RITA was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, RITA did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71).

Conclusions

The present PSM data meta-analysis suggests that the use of RITA compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.

Original languageEnglish
Pages (from-to)1083-1091
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number4
Early online date28 May 2016
DOIs
Publication statusPublished - Oct 2016

Structured keywords

  • Centre for Surgical Research

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