title: Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression.
abstract: Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during 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 michel_pompeu@yahoo.com.br.
authors.forename: Michel Pompeu Barros 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 Ferraz
authors.initials: PE
authors.lastname: Cavalcanti
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, Recife, Brazil University of Pernambuco, UPE, Recife, Brazil.
authors.forename: Henrique José de Andrade Costa
authors.initials: HJ
authors.lastname: Santos
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, Recife, Brazil University of Pernambuco, UPE, Recife, Brazil.
authors.forename: Artur Freire
authors.initials: AF
authors.lastname: Soares
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, Recife, Brazil University of Pernambuco, UPE, Recife, Brazil.
authors.forename: Rodrigo Gusmão Albuquerque
authors.initials: RG
authors.lastname: Miranda
authors.affiliation: Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, Recife, Brazil University of Pernambuco, UPE, Recife, Brazil.
authors.forename: Mayara Lopes
authors.initials: ML
authors.lastname: Araújo
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 / Q000379:methods; D006801:Humans; D008323:Mammary Arteries / Q000502:physiology / Q000601:surgery*; D014654:Vascular Patency
keywords: Blood flow velocity; Coronary artery bypass; Mammary arteries; Meta-analysis