External Stenting of Vein Grafts in Coronary Artery Bypass Grating: Interim Results from a Two Centers Prospective Study

Abstract

Background – previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in heterogeneous group of patients which underwent on and off-pump CABG, single and sequential grafting.Methods - 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts’ patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events.Results - 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n=16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100%, 100%, 98% and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced transient ischemic attack. Conclusions - External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates.Study registration- Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013)