Original research
Patency of skeletonized versus pedicled internal thoracic artery in coronary bypass graft surgery: A systematic review, meta-analysis and meta-regression

https://doi.org/10.1016/j.ijsu.2014.05.071Get rights and content
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Highlights

  • As for patency, skeletonized ITA seems to be non-inferior in comparison to pedicled ITA after CABG.

  • In sensitivity analysis, no difference regarding left or right ITA was also observed.

  • The meta-regression identified no modulating factors that could have influenced the results.

Abstract

Background

It is suggested that the skeletonization harvesting technique influences the patency rates of internal thoracic artery (ITA) after coronary artery bypass graft (CABG) surgery in comparison to conventional (pedicled) harvesting. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled ITA in terms of patency after CABG.

Methods

We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that performed angiographic evaluation within the first two years after CABG between these two groups until December 2013. The principal summary measures were odds ratio (OR) with 95% Confidence Interval (CI) and P values (statistically significant when <0.05). The OR's were combined across studies using weighted DerSimonian–Laird random effects model and weighted Mantel–Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey).

Results

Five studies involving 1764 evaluated conduits (1145 skeletonized; 619 pedicled) met the eligibility criteria. There was no evidence for important heterogeneity of effects among the studies. The overall OR (95% CI) for graft occlusion showed no statistical significant difference between groups (fixed effect model: OR 1.351, 95% CI 0.408 to 4.471, P = 0.801; random effect model: OR 1.351, 95% CI 0.408 to 4.471, P = 0.801). In sensitivity analysis, no difference regarding to left or right ITA was also observed. In meta-regression, we observed no statistically significant coefficients for graft occlusion and proportion of female, diabetics, renal failure, age, off-pump surgery or urgency, which means that the effect is not modulated by these factors.

Conclusion

In terms of patency, skeletonized ITA appears to be non-inferior in comparison to pedicled ITA after CABG.

Keywords

Meta-analysis
Coronary artery bypass
Mammary arteries
Vascular patency

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