Systematic review & Meta-analysis of comparative study between saphenous vein and radial artery as a conduit in coronary artery bypass grafting surgery

Abstract

The modern coronary artery surgery has developed on the foundation of testing several grafts and an attempt to standardize them, which has brought along the beginning of evidence-based cardiac surgery. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. While the choice of the 2nd conduit is still controversial.

We conducted this study to compare by meta-analysis the results of many previous studies, selected upon definitive inclusion & exclusion criteria, regarding the difference between the using of Radial artery & the Saphenous vein as a second conduit in coronary artery bypass graft surgery in the term of long term mortality & morbidity.

Our study included data from 15 cohort & case matched studies involving 78,267 patients in aggregate with a mean follow-up of 8.25 years.

The results of this study demonstrated significantly higher incidences of graft failure and complete occlusion for SV, and significantly higher incidences of graft patency rates for RA compared to SV. The study also shows that, the use of SV grafts is associated with higher rates of stroke, MACE, peri-opertaive mortality & myocardial infarction than those associated with the RA.

While the results of this study show that using of RA has higher rates of the need for revascularization either by PCI or coronary surgery repetition. This result was explained by the huge unmatched number of patients received SV grafts versus those received RA grafts in Janiec, et al. 2017 So, we recommend that the radial artery should be the first choice as a second conduit after the left internal mammary artery in coronary artery bypass surgeries.