title: Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach.
abstract: OBJECTIVE
  Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft?
  
  
  METHODS
  Meta-analysis by qualitative and quantitative protocol of the studies published in the literature in the last 15 years. Only eight, out of 149 observational studies found, met our criteria: surgical results of bilateral versus single IMA, patient age range from 20 to 89 years, exclusion of emergency and diabetic patients, study group larger than 100 patients, minimal follow-up time. The final sample size included 16362 patients.
  
  
  RESULTS
  Late survival was evaluated at 5 and 10 years. The hazard ratio (HR) was calculated from seven studies, the difference of survival was from six and five studies, respectively. The effect size was summarized using a random effect model, suggested by the results of statistical test for homogeneity of the HR (P < 0.05) and of the survival difference at 5 (P < 0.05) and at 10 years (P < 0.05). The bilateral IMA estimate of combined HR was 0.79 (95% confidence limits, C.L. = 0.66/0.91). The combined difference of survival probability at 5 years was 0.014 (95% C.L. = -0.03/0.06) and at 10 years was 0.07 (95% C.L. = 0.003/0.170).
  
  
  CONCLUSIONS
  There is significant evidence in favor of decreasing death risk of bilateral versus single IMA procedure.
authors.affiliation: Istituto Chirurgia Cardiovascolare, Università di Padova, FETCS, Istituto Chirurgia Cardiovascolare, Via Giustiniani 2, 35128 Padova, Italy. giulio.rizzoli@unipd.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Rizzoli
authors.forename: Laura
authors.initials: L
authors.lastname: Schiavon
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Bellini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome