Aortocoronary vs Composite Grafting Strategies in Coronary Artery Bypass Surgery – A Network Meta-Analysis

Unstructured Abstract Coronary artery bypass graft surgery (CABG) has traditionally utilised an in-situ left internal mammary artery (LIMA) graft to the left anterior descending artery, in addition to aortocoronary anastomoses to graft non-LAD target vessels. Composite grafting provides an opportunity to avoid aortic anastomoses by utilizing non-aortic anastomoses to provide greater efficiency in the use of conduits for improved all-cause mortality and reduced aortic manipulation to lower the incidence of postoperative stroke. We performed a network meta-analysis (NMA) to compare aortocoronary and various composite grafting strategies for CABG. A systematic search of six electronic databases identified all publications reporting outcomes of CABG with aortocoronary or composite grafting strategies. The primary outcome was in-hospital or 30-day all-cause mortality, and studies which reported this were included in a NMA. Our study protocol was registered with PROSPERO (CRD42023402665) and conformed with PRISMA 2020 and MOOSE guidelines. A systematic search of six electronic databases identified all publications reporting outcomes of the included operations. A total of 6656 articles were screened, of which 24 studies (8 RCTs and 16 observational studies) were included with a total of 9692 patients. There was no difference in conventional aortocoronary anastomosis and composite grafting for the outcome of in-hospital or 30-day all-cause mortality (p=0.387). There was also no difference in rates of stroke (p=0.277), myocardial infarction (p=0.09), reoperation for bleeding (p=0.500), postoperative atrial fibrillation (p=0.219) and deep sternal wound infection (p=0.549). This Bayesian NMA of 9692 patients demonstrated that composite grafting CABG can be performed as safely as conventional aortocoronary CABG.