Meta-Analysis on Coronary Artery Bypass Grafting With Single Versus Bilateral Internal Mammary Artery Grafts in Patients With End-Stage Renal Disease

Abstract

Patients with end-stage renal disease (ESRD) and concomitant coronary artery disease (CAD) present unique challenges for coronary revascularization. While coronary artery bypass grafting (CABG) is recommended over percutaneous coronary intervention in this population, the optimal surgical strategy remains controversial. This meta-analysis provides an updated comparison of outcomes for ESRD patients undergoing CABG with either bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafting. A total of nine studies involving 911 patients were included. Our findings revealed no significant differences in perioperative mortality (p = 0.57), deep sternal wound infection (p = 0.41), or major adverse cardiac and cerebrovascular events (p = 0.54) between groups. Long-term survival rates were also comparable at one, three, five, and seven years postoperatively. The pooled hazard ratio for all-cause mortality was 0.82 (95% CI: 0.61–1.12; p = 0.21), indicating no explicit survival advantage for either grafting strategy. These results are consistent with existing literature and suggest that both BITA and SITA grafting are safe and effective in this high-risk group. As medical advances continue to extend the life expectancy of patients with ESRD, additional research focused on optimizing the management of ESRD-related CAD will be essential to improving perioperative and long-term outcomes for these high-risk patients.