Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression
| Autor: | Henrique José de Andrade Costa Santos, Artur Freire Soares, Ricardo de Carvalho Lima, Michel Pompeu Barros de Oliveira Sá, Paulo Ernando Ferraz Cavalcanti, Mayara Lopes Araújo, Rodrigo Gusmão Albuquerque Miranda |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Internal thoracic artery law.invention Randomized controlled trial law medicine.artery Internal medicine Forest plot Medicine Humans Meta-regression Coronary Artery Bypass Mammary Arteries Vascular Patency business.industry General Medicine Publication bias Confidence interval Surgery medicine.anatomical_structure Meta-analysis Cardiology Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 48(1) |
| ISSN: | 1873-734X |
| Popis: | Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG. |
| Databáze: | OpenAIRE |
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