Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A network meta-analysis of clinical outcomes

Background There remains uncertainty regarding the second-best conduit after the internal thoracic artery in coronary artery bypass grafting. Few studies directly compared the clinical results of the radial artery (RA), right internal thoracic artery (RITA), and saphenous vein (SV). No network meta-analysis has compared these 3 strategies. Methods and Results andEMBASEwere searched for adjusted observational studies and randomized controlled trials comparing theRA,SV, and/orRITAas the second conduit for coronary artery bypass grafting. The primary end point was all-cause long-term mortality. Secondary end points were operative mortality, perioperative stroke, perioperative myocardial infarction, and deep sternal wound infection (DSWI). Pairwise and network meta-analyses were performed. A total of 149902 patients (4 randomized, 31 observational studies) were included (RA, 16201, SV, 112018, RITA,21683). AtNMA, the use ofSVwas associated with higher long-term mortality compared with theRA(incidence rate ratio, 1.23; 95%CI, 1.12-1.34) andRITA(incidence rate ratio, 1.26; 95%CI, 1.17-1.35). The risk ofDSWIforSVwas similar toRAbut lower thanRITA(odds ratio, 0.71; 95%CI, 0.55-0.91). There were no differences for any outcome betweenRITAandRA, althoughDSWItrended higher withRITA(odds ratio, 1.39; 95%CI, 0.92-2.1). The risk ofDSWIin bilateral internal thoracic artery studies was higher when the skeletonization technique was not used. Conclusions The use of theRAor theRITAis associated with a similar and statistically significant long-term clinical benefit compared with theSV. There are no differences in operative risk or complications between the 2 arterial conduits, butDSWIremains a concern with bilateralITAwhen skeletonization is not used.