The evolving evidence base for coronary artery bypass grafting and arterial grafting in 2021: How to improve vein graft patency

Vervoort, Dominique; Malik, Abdullah; Fremes, Stephen E.

doi:10.1016/j.xjtc.2021.09.038

Cited by 8 publications

(5 citation statements)

References 50 publications

(62 reference statements)

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“…10) In addition to surgical techniques, postoperative pharmacotherapy and control of coronary risk factors are also important in the suppression of the graft atherosclerosis. 2,28) The American Heart Association (AHA) recommends the use of antiplatelet therapy for life, and dual antiplatelet therapy over monotherapy with aspirin to improve graft patency in off-pump CABG. The SVG occlusion due to intimal hyperplasia and atheromatous plaque is related to increased levels of LDL cholesterol, so the AHA recommends that all CABG patients receive statin therapy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Graft Velocity on Saphenous Vein Graft Atherosclerosis after Coronary Artery Bypass Grafting

Nakamura

Honda

Kunimoto

et al. 2024

ATCS

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Purpose: Saphenous vein grafts (SVGs) sometimes occur as vein graft stenosis or failure in coronary artery bypass grafting. The purpose of this study was to detect the factors affecting vein graft atherosclerosis. Methods: We performed two analysis. In the first analysis, we enrolled 120 grafts using conventionally harvested saphenous vein graft (C-SVG) and followed-up with multiple coronary computed tomography angiography (CCTA). We examined the factors that contribute to the graft atherosclerosis defined by graft failure at subsequent CCTA or substantial progression of graft stenosis (a decrease of ≥0.6 mm in diameter). In the second analysis, 66 grafts using no-touch harvested saphenous vein graft (N-SVG) were compared with those in the first analysis using C-SVG, focusing on the differences in intraoperative factors using propensity score-matched analysis. Results: In the first analysis, graft atherosclerosis+ group comprised 27 grafts, which had a larger SVG diameter, lower graft velocity, and higher graft/native ratio in diameter than the graft atherosclerosis– group. In the multivariable analysis, slow graft velocity and graft/native ≥2 in diameter were independently associated with the graft atherosclerosis. In the second analysis, the N-SVG group had a much greater graft velocity than the C-SVG group. Conclusion: Lower graft velocity and higher graft/native ratio in diameter were associated with the graft atherosclerosis. The N-SVG group had increased graft velocity, which may contribute to prevent the graft atherosclerosis. (Trial registration: UMIN Clinical Trial Registry no. UMIN000050482. Registered 3 March 2023, retrospectively registered.)

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Section: Discussionmentioning

confidence: 99%

Impact of Graft Velocity on Saphenous Vein Graft Atherosclerosis after Coronary Artery Bypass Grafting

Nakamura

Honda

Kunimoto

et al. 2024

ATCS

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“…There is evidence that an arterial-venous composite graft provides advantages compared to aorto-venous proximal anastomosis. In the first setting, not only is the SVG subjected to a dampened pressure compared to the latter, but also, when the proximal anastomosis is connected to an internal mammary artery, the SVG experiences the beneficial effects of the vasodilatory, antithrombotic, and antiatherosclerosis mediators from the IMA [ 75 ]. SAVE-RITA was an RCT that compared SVG and RIMA as Y-composite grafts attached to the LIMA in situ, and it showed that the SVG was not inferior to the RIMA in terms of angiographic patency at 1-year follow-up [ 76 ].…”

Section: Surgical Techniquesmentioning

confidence: 99%

Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery

Gemelli,

Addonizio,

Geatti

et al. 2024

Medical Sciences

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Vein grafts are the most used conduits in coronary artery bypass grafting (CABG), even though many studies have suggested their lower patency compared to arterial alternatives. We have reviewed the techniques and technologies that have been investigated over the years with the aim of improving the quality of these conduits. We found that preoperative and postoperative optimal medical therapy and no-touch harvesting techniques have the strongest evidence for optimizing vein graft patency. On the other hand, the use of venous external support, endoscopic harvesting, vein preservation solution and anastomosis, and graft configuration need further investigation. We have also analyzed strategies to treat vein graft failure: when feasible, re-doing the CABG and native vessel primary coronary intervention (PCI) are the best options, followed by percutaneous procedures targeting the failed grafts.

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“…There is a steadily growing body of evidence supporting the use of NT-SV, with eight unique RCTs published to date with the longest follow-up out to 16 years reported by Samano et al [9,42]. However, there remains a need for studies powered for longterm mortality and MACCE.…”

Section: Long-term Clinical Outcomesmentioning

confidence: 99%

No-touch saphenous vein: current understanding of the conduit ‘less handled’

Deng,

Lee,

Vervoort

et al. 2024

Current Opinion in Cardiology

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Purpose of review The no-touch technique is an established method to harvest the saphenous vein (NT-SV), which is the most commonly used conduit in coronary artery bypass grafting. Herein, we summarize the foundational evidence, as well as highlight recent innovations and ongoing clinical trials involving NT-SV. Recent findings Through preservation of perivascular tissue for atraumatic handling and omission of manual distension, the NT-SV maintains endothelial nitrous oxide synthase levels and experiences less vascular smooth muscle cell activation, which translates to slower progression of atherosclerosis and less size mismatch of the graft and target vessel. These biomolecular advantages allow NT-SV to provide superior graft patency compared to conventional skeletonized saphenous vein and approximating that of the radial artery. Nonetheless, the clinical benefits of NT-SV for mortality and reduction in major adverse cardiac and cerebrovascular events are insufficiently studied in the long-term. The drawback of NT-SV is the short-term harvest site complications, which may potentially be addressed by the advent of endoscopic no-touch technique. Summary NT-SV is a promising conduit, and its role will be further clarified in upcoming clinical trials and as follow-up lengthens. However, conduit selection and harvest technique should ultimately be personalized to the individual patient.

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The evolving evidence base for coronary artery bypass grafting and arterial grafting in 2021: How to improve vein graft patency

Abstract: Improving saphenous vein graft patency for coronary artery bypass grafting.

Cited by 8 publications

References 50 publications

Impact of Graft Velocity on Saphenous Vein Graft Atherosclerosis after Coronary Artery Bypass Grafting

Impact of Graft Velocity on Saphenous Vein Graft Atherosclerosis after Coronary Artery Bypass Grafting

Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery

No-touch saphenous vein: current understanding of the conduit ‘less handled’

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