Multiple Versus Single Arterial Grafting In The Elderly: A Meta-Analysis Of Randomized Controlled Trials And Propensity Score Studies.

Introduction The benefit of total arterial revascularization versus the use of venous grafts in addition to an arterial conduit is still an unsettled issue in coronary artery bypass grafting (CABG) surgery, especially in higher-risk subgroups due to lack of evidence, namely in the elderly. Objectives We conducted a meta-analysis of randomized controlled trials (RCTs), and propensity score (PS) studies comparing survival and early results of elderly patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG). Materials and Methods MEDLINE, Web of Science, and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a follow-up ≥ 1 year and early outcomes were evaluated. Outcomes were collected through hazard ratio (HR) and their variance, frequencies from the matched sample, or adjusted odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events). Results Eleven PS cohorts and 2 RCTs comprising >20,000 patients (>6800MAG and >13,200 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.80, 95%CI: 0.72-0.88, p<0.01) at no expense of higher risk of early mortality (pooled OR: 0.81, 95%CI: 0.57-1.15, p=0.24), but a propensity for MAG being associated with increased risk of sternal wound complications (SWC) was found (OR MAG BIMA: 1.42, 95%CI: 0.98-2.06, p=0.07). Conclusions Advanced age should not limit MAG's use considering its long-term survival benefits, even within the elderly. However, the tendency for higher rates of SWC with MAG calls for a careful selection of patients to this challenging technique.