Optimization in long-term survival after multiple arterial grafting in coronary artery bypass: A systematic review and meta-analysis

IntroductionSurgical revascularization through coronary artery bypass is a widely accepted approach for treating diseases affecting multiple coronary vessels. While the standard approach uses a single arterial graft combined with vein grafts, using numerous arterial grafts may improve long-term outcomes. Although supported by observational data and guideline recommendations, the broader adoption of multiple arterial grafting has been limited due to a lack of definitive randomized trial evidence and uncertainties in specific patient subgroups.MethodsA systematic review and meta-analysis were conducted to compare long-term survival in patients receiving multiple versus single arterial grafts during coronary artery bypass surgery. Twenty-seven studies (including one randomized trial) involving more than one million patients were included. The primary outcome was long-term all-cause mortality. Hazard ratios with 95% confidence intervals were pooled using a random-effects model. Subgroup analyses were performed based on age, sex, diabetes status, graft conduit type, extent of arterial revascularization, and left ventricular function. Meta-regression examined the impact of patient characteristics.ResultsMultiple arterial grafting was associated with a significant reduction in long-term mortality compared to single arterial grafting. The pooled hazard ratio indicated an approximate 20% relative reduction in mortality. This survival benefit was consistent across all evaluated subgroups. Meta-regression did not identify any patient characteristic that significantly altered the benefit of multiple arterial grafting. No significant publication bias was detected.ConclusionMultiple arterial grafting is associated with improved long-term survival in coronary artery bypass surgery. These findings support the broader implementation of this strategy in suitable patients while emphasizing the need for individualized surgical decision-making.