Royse A, Ren J, Royse C, Tian DH, Fremes S, Gaudino M, Benedetto U, Woo YJ, Goldstone AB, Davierwala P, Borger M, Vallely M, Reid CM, Rocha R, Glineur D, Grau J, Shaw R, Paterson H, El-Ansary D, Boggett S, Srivastav N, Pawanis Z, Canty D, Bellomo R: Coronary artery bypass surgery without saphenous vein grafting: JACC review topic of the week. J Am Coll Cardiol 2022; 80: 1833-1843- Outcomes Research Consortium

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Royse A, Ren J, Royse C, Tian DH, Fremes S, Gaudino M, Benedetto U, Woo YJ, Goldstone AB, Davierwala P, Borger M, Vallely M, Reid CM, Rocha R, Glineur D, Grau J, Shaw R, Paterson H, El-Ansary D, Boggett S, Srivastav N, Pawanis Z, Canty D, Bellomo R: Coronary artery bypass surgery without saphenous vein grafting: JACC review topic of the week. J Am Coll Cardiol 2022; 80: 1833-1843

March 28, 2022

ABSTRACT
Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N ¼ 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77; 95% CI: 0.71-0.84; P < 0.001). An expanded analysis with a new unpublished data set (N ¼ 63,288 matched patients) was combined with the literature review (N ¼ 127,565). It found reduced all-cause mortality for TAR (HR: 0.78; 95% CI: 0.72-0.85; P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality. (J Am Coll Cardiol 2022;80:1833–1843) Crown Copyright © 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).