Saphenous Vein Graft Failure after Coronary Artery Bypass Surgery: Insights from PREVENT IV

Monday, October 20, 2014

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Source

Source Name: Circulation

Source URL: http://www.ncbi.nlm.nih.gov/pubmed/25261549

Author(s)

Hess CN , Lopes RD, Gibson CM, Hager R, Wojdyla DM, Englum BR, Mack M, Califf R, Kouchoukos NT, Peterson ED, Alexander JH

In this paper, the authors aim to further understand the factors associated with vein graft failure (VGF) after CABG. They used data on 1828 participants in the PREVENT IV trial to identify patient and surgical factors associated with VGF. They found that longer surgical duration, endoscopic vein harvesting, poor target artery quality and postoperative clopidogrel use were independently associated with VGF. These findings will help identifying patients at high risk of VGF, as well as helping to develop interventions with lower rates of VGF.

Comments

Submitted by Ferenc Tarr on Fri, 2014-10-24 02:55

"At 12 to 18 months post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. " One may get the feeling, that a travel back to the past is offered by this publication. Especially, when the above cited "results" are surfaced. I would like to meet those present day heart surgeons, who do use saphenous veins for CABG, save secondary or tertiary coronary vessels- especially in the light of the above cited "results"... There is an abundance of literature proving, that patency rate of arterial grafts like BIMAs, radial, inferior epigastric artery utilized for CABG are well over 15, 20 years! Exclusively, the LIMA-LAD - as the most common type of grafting has been proved to be patent over 95% in decades of time, due to its NO production creating a special biochemical milieu in the recipient coronary artery. The main effects are: vasodilatation, blocking thrombocyte adhesion and aggregation by which the recipient coronary artery seems to become resistent to atherogenic process. Professor Dion composed a solution in the past century (in the '80s) to prevent endothelial damage of the vein graft being harvested. The partient's own blood is mixed with heparin and papaverine, titrated to neutral pH, which preserves the vein. This cannot be performed during endoscopic harvesting One can see, that many "modern" methodology should be abandoned, ad thererfor it looks pointless to analyze the outcome of OUTDATED SURGICAL PRACTICES, unless there would be an unintentional drive to discredit coronary surgery.