title: Patency of skeletonized versus pedicled internal thoracic artery in coronary bypass graft surgery: a systematic review, meta-analysis and meta-regression.
abstract: BACKGROUND
  It is suggested that the skeletonization harvesting technique influences the patency rates of internal thoracic artery (ITA) after coronary artery bypass graft (CABG) surgery in comparison to conventional (pedicled) harvesting. We conducted a meta-analysis to determine whether there is any difference between skeletonized versus pedicled ITA in terms of patency after CABG.
  
  
  METHODS
  We performed a systematic-review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that performed angiographic evaluation within the first two years after CABG between these two groups until December 2013. The principal summary measures were odds ratio (OR) with 95% Confidence Interval (CI) and P values (statistically significant when <0.05). The OR's were combined across studies using weighted DerSimonian-Laird random effects model and weighted Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey).
  
  
  RESULTS
  Five studies involving 1764 evaluated conduits (1145 skeletonized; 619 pedicled) met the eligibility criteria. There was no evidence for important heterogeneity of effects among the studies. The overall OR (95% CI) for graft occlusion showed no statistical significant difference between groups (fixed effect model: OR 1.351, 95% CI 0.408 to 4.471, P = 0.801; random effect model: OR 1.351, 95% CI 0.408 to 4.471, P = 0.801). In sensitivity analysis, no difference regarding to left or right ITA was also observed. In meta-regression, we observed no statistically significant coefficients for graft occlusion and proportion of female, diabetics, renal failure, age, off-pump surgery or urgency, which means that the effect is not modulated by these factors.
  
  
  CONCLUSIONS
  In terms of patency, skeletonized ITA appears to be non-inferior in comparison to pedicled ITA after CABG.
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br.
authors.forename: Michel Pompeu Barros de Oliveira
authors.initials: MP
authors.lastname: Sá
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Paulo Ernando
authors.initials: PE
authors.lastname: Ferraz
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Rodrigo Renda
authors.initials: RR
authors.lastname: Escobar
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Eliobas Oliveira
authors.initials: EO
authors.lastname: Nunes
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lustosa
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil.
authors.forename: Frederico Pires
authors.initials: FP
authors.lastname: Vasconcelos
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Ricardo Carvalho
authors.initials: RC
authors.lastname: Lima
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D008323:Mammary Arteries / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Coronary artery bypass; Mammary arteries; Meta-analysis; Vascular patency