Jiao He, Li Jinghui, Bai Yunpeng, Guo Zhigang
Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
Department of Cardiac Surgery, Chest Hospital, Tianjin University, Tianjin, China.
Front Cardiovasc Med. 2022 Jul 22;9:944717. doi: 10.3389/fcvm.2022.944717. eCollection 2022.
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).
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 I 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.
The 15 studies were analyzed, including 22,004 patients, 4,580 grafts, and seven 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.
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.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022326992.
进行一项队列研究的系统评价和荟萃分析，以比较冠状动脉旁路移植术（CABG）中序贯式与个体化大隐静脉移植血管（SVG）的通畅率及不良结局。
我们在PubMed、Embase和Cochrane图书馆中检索队列研究。将静脉移植血管失败、围手术期及随访不良事件的终点指标提取为风险比（RR）及95%置信区间（95%CI）。采用I统计量检验各研究间的统计异质性。通过Egger检验对发表偏倚的可能性进行定量评估。还进行了敏感性分析以评估我们结果的稳健性。
共分析了15项研究，包括22,004例患者、4,580根移植血管，以及个体化或序贯式CABG下的7种不同不良事件。序贯组的移植血管失败率（RR = 0.68；95%CI，0.60 - 0.77）和长期死亡率（RR = 0.76；95%CI，0.61 - 0.95）较低，但围手术期再次血管重建的风险（RR = 1.58；95%CI，1.16 - 2.14）高于个体化组。
总体而言，我们对比较冠心病患者序贯式与个体化大隐静脉移植血管的汇总证据分析表明，序贯式移植血管的使用分别与较低的移植血管失败率和长期死亡率相关，但围手术期再次血管重建的风险增加。根据我们的研究，两种手术技术在疗效和安全性方面都有各自的优势，手术技术的选择应基于患者和外科医生。序贯式大隐静脉移植血管应更多地推荐给经验丰富的外科医生，以既减少围手术期不良事件又提高长期通畅率。
