Abstract
ObjectivesLow patency rates of saphenous vein grafts remain a major predicament in surgical revascularization. We examined a novel expandable external support device designed to mitigate causative factors for early and late graft failure.MethodsFor this study, fourteen adult sheep underwent cardiac revascularization using two vein grafts for each; one to the LAD and the other to the obtuse marginal artery. One graft was supported with the device while the other served as a control. Target vessel was alternated between consecutive cases. The animals underwent immediate and late angiography and were then sacrificed for histopathologic evaluation.ResultsOf the fourteen animals studied, three died peri-operatively (unrelated to device implanted), and ten survived the follow-up period. Among surviving animals, three grafts were thrombosed and one was occluded, all in the control group (p = 0.043). Quantitative angiographic evaluation revealed no difference between groups in immediate level of graft uniformity, with a coefficient-of-variance (CV%) of 7.39 in control versus 5.07 in the supported grafts, p = 0.082. At 12 weeks, there was a significant non-uniformity in the control grafts versus the supported grafts (CV = 22.12 versus 3.01, p < 0.002). In histopathologic evaluation, mean intimal area of the supported grafts was significantly lower than in the control grafts (11.2 mm^2 versus 23.1 mm^2 p < 0.02).ConclusionsThe expandable SVG external support system was found to be efficacious in reducing SVG’s non-uniform dilatation and neointimal formation in an animal model early after CABG. This novel technology may have the potential to improve SVG patency rates after surgical myocardial revascularization.
Highlights
Coronary artery disease (CAD) is the leading cause of death worldwide [1]
The treatment of choice for patients who suffer from severe CAD is coronary artery bypass grafting surgery (CABG) in which the internal mammary arteries (IMAs) and greater saphenous veins are utilized as coronary conduits
While early vein graft occlusion is mainly due to technical aspects of the surgical procedure, intermediate and late graft failure results from an irregular remodeling and dilatation of the pressurized thin walled graft [7,8,9] with subsequent intimal hyperplasia and wall thickening, that reduces the graft’s luminal area and may promote atheroma formation
Summary
Coronary artery disease (CAD) is the leading cause of death worldwide [1]. The treatment of choice for patients who suffer from severe CAD is coronary artery bypass grafting surgery (CABG) in which the internal mammary arteries (IMAs) and greater saphenous veins are utilized as coronary conduits. While early vein graft occlusion is mainly due to technical aspects of the surgical procedure, intermediate and late graft failure results from an irregular remodeling and dilatation of the pressurized thin walled graft [7,8,9] with subsequent intimal hyperplasia and wall thickening, that reduces the graft’s luminal area and may promote atheroma formation. These developments are thought to be a consequential intrinsic adaptation of the thin walled vein to arterial longitudinal, circumferential and pulsatile flow and pressures [7,10,11]
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