Abstract
Backgroundprevious 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 a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting.Methods102 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.Results51 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 a 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 a transient ischemic attack.ConclusionsExternal 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.Trial registrationStudy was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).
Highlights
Coronary artery bypass grafting (CABG) remains the gold standard treatment for multivessel coronary artery disease [1]
The longterm outcome of CABG is still limited by the poor longevity of saphenous vein grafts (SVG), the most commonly used type of conduit [2]
The root causes of SVG disease were discovered decades ago, these findings were not translated into the clinical setting in which only 50% of vein grafts are patent 10 years after CABG [3]
Summary
Coronary artery bypass grafting (CABG) remains the gold standard treatment for multivessel coronary artery disease [1]. The longterm outcome of CABG is still limited by the poor longevity of saphenous vein grafts (SVG), the most commonly used type of conduit [2]. The root causes of SVG disease were discovered decades ago, these findings were not translated into the clinical setting in which only 50% of vein grafts are patent 10 years after CABG [3]. The accelerated SVG disease is attributed to early structural remodeling of the vein due to exposure to the hemodynamics of the arterial circulation and the development of intimal hyperplasia [4, 5]. Except for statins and beta- blockers, pharmacological attempts to mitigate vein graft disease have shown limited success [6]. Surgical approaches to reduce SVG disease, which were focused on optimization of the harvesting method, have shown that a no-touch technique leads to a significant increase in SVG patency compared to conventional harvesting [7]
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