title: A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting.
abstract: BACKGROUND
  Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival.
  
  
  METHODS
  Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies.
  
  
  RESULTS
  No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001].
  
  
  CONCLUSIONS
  In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.
authors: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York City, New York, USA; ; The Collaborative Research (CORE) Group, Sydney, Australia;
authors: Aaron J
authors: AJ
authors: Weiss
authors: Shan
authors: S
authors: Zhao
authors: David H
authors: DH
authors: Tian
authors: David P
authors: DP
authors: Taggart
authors: Tristan D
authors: TD
authors: Yan
keywords: Internal mammary artery; bilateral; coronary artery bypass; meta-analysis
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