Coronary Artery Bypass Surgery Without Saphenous Vein Grafting

作者：Alistair George Royse, Justin Ren, Colin Forbes Royse, David H. Tian, Stephen Edward Fremes, Mario F.L. Gaudino, Umberto Benedetto, Yi-Ping Joseph Woo, Andrew Brooks Goldstone, Piroze Minoo Davierwala, Michael Andrew Borger, Michael Patrick Vallely, Christopher Michael Reid, Rodolfo V. Rocha, David Glineur, Juan B. Grau, Richard E. Shaw, Hugh S. Paterson, Doa El‐Ansary, Stuart Boggett, Nilesh Srivastav, Zulfayandi Pawanis, David Jeffrey Canty, Rinaldo Bellomo · 发表于：Journal of the American College of Cardiology · 年份：2022 · DOI：10.1016/j.jacc.2022.08.795 · 被引用次数：23 · 研究领域：Cardiac and Coronary Surgery Techniques、Cardiac, Anesthesia and Surgical Outcomes、Coronary Interventions and Diagnostics

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 An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565).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.