AUTHOR=Jiao He , Li Jinghui , Bai Yunpeng , Guo Zhigang 

TITLE=Patency and adverse outcomes of sequential vs. individual saphenous vein grafts in coronary artery bypass: A meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.944717

DOI=10.3389/fcvm.2022.944717

ISSN=2297-055X

ABSTRACT=Objectives
To undertake a systematic review and meta-analysis of cohort studies to compare the patency and adverse outcomes of sequential and individual saphenous vein grafts (SVGs) in coronary artery bypass grafting (CABG).
Methods
We searched PubMed, Embase, and the Cochrane Library for cohort studies. Endpoints for vein graft failure, perioperative and follow-up adverse events were extracted as risk ratio (RR) with 95% confidence intervals (95% CI). Statistical heterogeneity across the studies was examined using the I2 statistic. Potential of publication bias was evaluated quantitatively by the Egger’s test. Sensitivity analysis was also performed to assess the robustness of our outcomes.
Results
The 15 studies were analyzed, including 22,004 patients, 4580 grafts, and 7 different adverse events under individual or sequential CABG. The sequential group had inferior graft failure (RR=0.68; 95% CI, 0.60-0.77) and long-term mortality (RR=0.76; 95%CI, 0.61-0.95), but with an increased risk of perioperative repeat revascularization (RR=1.58; 95%CI, 1.16-2.14) than the individual group.
Conclusion
Taken together, our analysis of the aggregated evidence comparing the sequential and individual saphenous vein grafts for coronary heart disease patients showed that the use of the sequential graft was associated with inferior graft failure and long-term mortality respectively, but with an increased risk of perioperative repeat revascularization. According to our study, both surgical techniques have their own advantages in efficacy and safety, and the selection of surgical techniques should be based on patients and surgeons. Sequential saphenous vein grafts should be more recommended to experienced surgeons in order to both reduce perioperative adverse events and improve long-term patency.