المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Donovan, Terrence John² (AUTHOR), Edelstein, Stav³ (AUTHOR), Puskas, John D⁴ (AUTHOR), Angleitner, Philipp¹ (AUTHOR), Krasopoulos, George⁵ (AUTHOR), Channon, Keith⁶ (AUTHOR), Gehrig, Thomas² (AUTHOR), Rajakaruna, Cha⁷ (AUTHOR), Ladyshenskij, Leonid⁸ (AUTHOR), Silva, Ravi De⁹ (AUTHOR), Bonaros, Nikolaos¹⁰ (AUTHOR), Bolotin, Gil¹¹ (AUTHOR), Jacobs, Stephan¹² (AUTHOR), Thielmann, Matthias¹³ (AUTHOR), Choi, Yeong-Hoon¹⁴ (AUTHOR), Ohri, Sunil¹⁵ (AUTHOR), Lipey, Alexander¹⁶ (AUTHOR), Friedrich, Ivar² (AUTHOR), Taggart, David P⁵ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Jul2022, Vol. 62 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *CORONARY artery bypass, *VEIN diseases, *INTRAVASCULAR ultrasonography, *CORONARY angiography, *HARVESTING, *SAPHENOUS vein

مستخلص: Open in new tab Download slide OBJECTIVES In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. METHODS Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. RESULTS Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. CONCLUSIONS A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting. [ABSTRACT FROM AUTHOR]

المؤلفون: Stephan Jacobs, Ravi De Silva, Matthias Thielmann, Sunil K. Ohri, Mohamad N. Bittar, Rajesh K. Kharbanda, Ivar Friedrich, Amal Bose, George Krasopoulos, Alexandros Paraforos, Daniel Wendt, Marius Berman, Oliver J. Liakopoulos, Cha Rajakaruna, Thomas Schachner, Thomas R. Gehrig, Joseph Zacharias, Umberto Benedetto, Philipp Angleitner, Yulia Gavrilov, Nikolaos Bonaros, Yeong-Hoon Choi, Sigrid Sandner, Terrence John Donovan, David P. Taggart, Gil Bolotin, Keith M. Channon, Hunaid A. Vohra, Leonid Ladyshenskij, Alexander Lipey

المساهمون: InVESTigators, Benedetto, Umberto (Beitragende*r), Vohra, Hunaid (Beitragende*r), Bittar, Mohamad Nidal (Beitragende*r), Bose, Amal (Beitragende*r), Berman, Marius (Beitragende*r), Kharbanda, Rajesh (Beitragende*r), Paraforos, Alexandros (Beitragende*r), Ladyshenskij, Leonid (Beitragende*r), Bonaros, Nikolaos (Beitragende*r), Schachner, Thomas (Beitragende*r), Sandner, Sigrid (Beitragende*r), Angleitner, Philipp (Beitragende*r), Bolotin, Gil (Beitragende*r), Jacobs, Stephan (Beitragende*r), Thielmann, Matthias Klaus (Beitragende*r), Wendt, Daniel (Beitragende*r), Choi, Yeong-Hoon (Beitragende*r), Liakopoulos, Oliver (Beitragende*r), Ohri, Sunil (Beitragende*r), Lipey, Alexander (Beitragende*r)

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Intimal hyperplasia, medicine.medical_treatment, Medizin, Coronary Artery Disease, Internal thoracic artery, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine.artery, Intravascular ultrasound, Humans, Medicine, Saphenous Vein, Coronary Artery Bypass, Vascular Patency, Computed tomography angiography, Hyperplasia, medicine.diagnostic_test, business.industry, Stent, medicine.disease, Surgery, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, Angiography, Disease Progression, Stents, Cardiology and Cardiovascular Medicine, business, Artery

الوصف: Objectives Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease. Methods A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years. Results Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001). Conclusions Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::31d0f111006319341743575a0031db62Test
https://ora.ox.ac.uk/objects/uuid:cc37fff7-fb18-4677-9915-24e6ba021aafTest