Comparative Outcomes of Multiarterial Versus Single Arterial Grafting in Patients with Reduced Left Ventricular Ejection Fraction Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis.

Ischemic cardiomyopathy with reduced left ventricular ejection fraction presents considerable outcome-related challenges, even with the development of surgical revascularization. Coronary artery bypass grafting continues to be a key therapy, yet the best grafting technique, single arterial grafting (SAG) versus multiarterial grafting (MAG) for patients with reduced EF, is uncertain. This systematic review and meta-analysis aims to assess the comparative outcomes of MAG versus SAG in this high-risk group. Fourteen cohort studies consisting of 19,976 patients were studied, with 10,306 receiving MAG and 9670 receiving SAG. The primary outcomes are 5-year overall survival, cardiac death, and in-hospital mortality, while secondary outcomes include major adverse cardiovascular events, perioperative myocardial infarction, repeat revascularization, atrial fibrillation, postoperative dialysis, stroke, intensive care unit/hospital stay, and sternal wound infection. MAG was notably related to improved 5-year survival [odds ratio (OR), 1.50; 95% confidence interval (CI), 1.32-1.70; P < 0.00001] and reduced in-hospital mortality (OR, 0.66; 95% CI, 0.55-0.79; P < 0.00001). While cardiac mortality was not statistically significant, secondary outcomes were generally similar between groups. Sensitivity analyses validated the robustness of findings, and Grading of Recommendations Assessment, Development, and Evaluation assessments confirmed moderate to high certainty of evidence. No considerable publication bias was noted. Despite the lack of randomized controlled trials, this review underscores the improved survival of MAG without increased perioperative risk in patients with left ventricular ejection fraction <50%. These outcomes indicate that MAG may be suitable in select cases, though further randomized studies are required to confirm these results and guide optimized decision-making.