Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
Cleveland Clinic, Cleveland, OH.
J Am Heart Assoc. 2018 May 17;7(11):e009361. doi: 10.1161/JAHA.118.009361.
This meta-analysis was designed to assess whether center experience affects the short- and long-term results and the relative benefits of bilateral internal thoracic artery grafting (BITA) for coronary artery bypass grafting.
MEDLINE and EMBASE were searched to identify all articles reporting the outcome of BITA in patients undergoing coronary artery bypass grafting. The BITA center experience was gauged according to the percentage use of BITA in the institutional overall coronary artery bypass grafting population (%BITA). The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality, perioperative myocardial infarction, perioperative stroke, deep sternal wound infections (DSWIs), and major postoperative adverse event. The rates of the primary and secondary outcomes were calculated after adjusting for %BITA. Primary and secondary outcomes were also compared between the BITA and the single internal thoracic artery arms in the adjusted studies. Meta-regression was used to evaluate the effect of %BITA on the primary and secondary outcomes. Thirty-four studies (27 894 patients undergoing BITA) were included. In the pooled analysis, the incidence rate for long-term mortality was 2.83% (95% confidence interval, 2.21%-3.61%). %BITA was significantly and inversely associated with long-term mortality and the rate of DSWI. In the pairwise comparison, %BITA was significantly and inversely associated with the risk of long-term mortality and DSWI in the group undergoing BITA.
BITA series with higher %BITA report significantly lower long-term mortality and DSWI rate as well as higher long-term survival advantage and lower relative risk of DSWI in their BITA cohort. These findings suggest that a specific volume-outcome relationship exists for BITA grafting.
本荟萃分析旨在评估中心经验是否会影响双侧胸廓内动脉移植（BITA）用于冠状动脉旁路移植术的短期和长期结果以及相对益处。
检索 MEDLINE 和 EMBASE 以确定所有报告接受冠状动脉旁路移植术的患者 BITA 结果的文章。根据机构内整体冠状动脉旁路移植人群中 BITA 的使用百分比（%BITA）来衡量 BITA 中心经验。主要结局是长期全因死亡率。次要结局是手术死亡率、围手术期心肌梗死、围手术期卒中、深部胸骨伤口感染（DSWI）和主要术后不良事件。在调整 %BITA 后计算主要和次要结局的发生率。在调整后的研究中，还比较了 BITA 和单根胸廓内动脉臂的主要和次要结局。使用元回归评估 %BITA 对主要和次要结局的影响。纳入 34 项研究（27894 例接受 BITA 的患者）。在汇总分析中，长期死亡率的发生率为 2.83%（95%置信区间，2.21%-3.61%）。%BITA 与长期死亡率和 DSWI 发生率呈显著负相关。在成对比较中，在接受 BITA 的组中，%BITA 与长期死亡率和 DSWI 的风险呈显著负相关。
报告的 %BITA 较高的 BITA 系列报告显示，其 BITA 队列的长期死亡率和 DSWI 发生率显著降低，长期生存率优势更高，DSWI 的相对风险更低。这些发现表明 BITA 移植存在特定的量效关系。
