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Coronary Artery Bypass Surgery Without Saphenous Vein Grafting: JACC Review Topic of the Week. Journal of the American College of Cardiology Royse, A., Ren, J., Royse, C., Tian, D. H., Fremes, S., Gaudino, M., Benedetto, U., Woo, Y. J., Goldstone, A. B., Davierwala, P., Borger, M., Vallely, M., Reid, C. M., Rocha, R., Glineur, D., Grau, J., Shaw, R., Paterson, H., El-Ansary, D., Boggett, S., Srivastav, N., Pawanis, Z., Canty, D., Bellomo, R. 2022; 80 (19): 1833-1843

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 An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565).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

View details for DOI 10.1016/j.jacc.2022.08.795

View details for PubMedID 36328694