Cardiothoracic Department, St George Hospital, Sydney, Australia.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):735-738. doi: 10.1093/icvts/ivac021.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'What is the best choice for third conduit when using bilateral internal mammary arteries for coronary artery bypass grafting-radial artery or saphenous vein graft?'. Altogether >525 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Overall, there was no survival benefit demonstrated with the use of a radial artery over the use of a saphenous vein graft as a choice of third conduit following bilateral internal mammary artery grafts for coronary artery bypass grafting. The main limitation of the current evidence available is the restricted follow-up periods and the high attrition rates with small sample sizes affecting the strength of conclusions that can be drawn beyond 10 years of follow-up. We conclude that despite previous evidence supporting improved long-term patency of radial arterial grafts, there is no strong evidence that the use of a radial artery, over a saphenous vein graft, has any survival benefit when used as the third conduit following bilateral internal mammary artery grafts.
一个心脏外科学的最佳证据主题是按照一个结构化的方案编写的。提出的问题是：“在使用双侧内乳动脉进行冠状动脉旁路移植术时，第三根移植物是桡动脉还是大隐静脉？”。总共使用报道的搜索方法找到了超过 525 篇论文，其中 7 篇论文提供了最佳证据来回答临床问题。作者、期刊、日期和出版国家、研究的患者群体、研究类型、这些论文的相关结果都列在表中。总的来说，与使用大隐静脉作为第三根移植物相比，在双侧内乳动脉搭桥后使用桡动脉作为第三根移植物并不能提高生存率。目前可用证据的主要局限性是随访时间有限，以及小样本量导致的高失访率，这影响了在 10 年以上随访期后得出结论的可信度。我们的结论是，尽管之前有证据支持桡动脉移植物具有更好的长期通畅率，但在使用双侧内乳动脉搭桥后，将桡动脉作为第三根移植物与大隐静脉相比，并没有任何生存获益的有力证据。
