Dataset Information

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

ABSTRACT:

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.).

SUBMITTER: Nakamura R

PROVIDER: S-EPMC10902658 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Nakamura Ryo R Honda Kentaro K Kunimoto Hideki H Fujimoto Takahiro T Agematsu Kota K Nishimura Yoshiharu Y

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 20230719 1

<h4>Purpose</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 37468261

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Project description:BackgroundCoronary artery bypass grafting success is limited by vein graft failure (VGF). Understanding the factors associated with VGF may improve patient outcomes.Methods and resultsWe examined 1828 participants in the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial undergoing protocol-mandated follow-up angiography 12 to 18 months post-coronary artery bypass grafting or earlier clinically driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected by using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models by using logistic regression without and with generalized estimating equations. 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. Demographic and clinical characteristics were similar between patients with and without VGF, although VGF patients had longer surgical times, worse target artery quality, longer graft length, and they more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95% confidence interval, 1.16-1.71), poor target artery quality (odds ratio, 1.43; 95% confidence interval, 1.11-1.84), and postoperative use of clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval, 1.07-1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%.ConclusionsVGF is common and associated with patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF.Clinical trial registration urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00042081.

Project description:Background Perivascular adipose tissue (PVAT) is associated with metabolically driven chronic inflammation called metaflammation, which contributes to vascular function and the pathogenesis of vascular disease. The saphenous vein (SV) is commonly used as an essential conduit in coronary artery bypass grafting, but the long-term patency of SV grafts is a crucial issue. The use of the novel "no-touch" technique of SV harvesting together with its surrounding tissue has been reported to result in good long‑term graft patency of SV grafts. Herein, we investigated whether PVAT surrounding the SV (SV-PVAT) has distinct phenotypes compared with other PVATs of vessels. Methods and Results Fat pads were sampled from 48 patients (male/female, 32/16; age, 72±8 years) with coronary artery disease who underwent elective coronary artery bypass grafting. Adipocyte size in SV-PVAT was significantly larger than the sizes in PVATs surrounding the internal thoracic artery, coronary artery, and aorta. SV-PVAT and PVAT surrounding the internal thoracic artery had smaller extents of fibrosis, decreased gene expression levels of fibrosis-related markers, and less metaflammation, as indicated by a significantly smaller extent of cluster of differentiation 11c-positive M1 macrophage infiltration, higher gene expression level of adiponectin, and lower gene expression levels of inflammatory cytokines, than did PVATs surrounding the coronary artery and aorta. Expression patterns of adipocyte developmental and pattern-forming genes were totally different among the PVATs of the vessels. Conclusions The phenotype of SV-PVAT, which may result from inherent differences in adipocytes, is closer to that of PVAT surrounding the internal thoracic artery than that of PVAT surrounding the coronary artery or that of PVAT surrounding the aorta. SV-PVAT has less metaflammation and consecutive adipose tissue remodeling, which may contribute to high long-term patency of grafting when the no-touch technique of SV harvesting is used.

Project description:ImportanceObservational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials.ObjectiveTo compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up.Design, setting, and participantsPatient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019.InterventionsPatients were randomized to undergo either radial artery (n?=?534) or saphenous vein (n?=?502) grafts for coronary artery bypass grafting.Main outcomes and measuresThe primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction.ResultsA total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P?<?.001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P?=?.01).Conclusions and relevanceIn this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.

Dataset Information

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

Purpose

Methods

Results

Conclusion

Publications

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

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