المؤلفون: Sandner, Sigrid^1,2 (AUTHOR), Redfors, Björn³ (AUTHOR), Angiolillo, Dominick J.⁴ (AUTHOR), Audisio, Katia⁵ (AUTHOR), Fremes, Stephen E.^6,7 (AUTHOR), Janssen, Paul W.A.⁸ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Mehran, Roxana¹⁰ (AUTHOR), Peper, Joyce⁸ (AUTHOR), Ruel, Marc¹¹ (AUTHOR), Saw, Jacqueline^12,13 (AUTHOR), Soletti, Giovanni Jr⁵ (AUTHOR), Starovoytov, Andrew¹² (AUTHOR), ten Berg, Jurrien M.⁸ (AUTHOR), Willemsen, Laura M.⁸ (AUTHOR), Zhao, Qiang¹⁴ (AUTHOR), Zhu, Yunpeng¹⁴ (AUTHOR), Gaudino, Mario⁵ (AUTHOR) mfg9004@med.cornell.edu

المصدر: JAMA: Journal of the American Medical Association. 8/9/2022, Vol. 328 Issue 6, p554-562. 9p.

مصطلحات موضوعية: *SAPHENOUS vein, *RESEARCH, *CORONARY artery bypass, *CLINICAL trials, *META-analysis, *RESEARCH methodology, *SYSTEMATIC reviews, *SURGICAL complications, *MEDICAL care, *EVALUATION research, *TREATMENT effectiveness, *VASCULAR grafts, *CARDIOVASCULAR system, *COMPARATIVE studies, *PLATELET aggregation inhibitors, *ASPIRIN, *HEMORRHAGE, PREVENTION of surgical complications

مستخلص: Importance: The role of ticagrelor with or without aspirin after coronary artery bypass graft surgery remains unclear.Objective: To compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery.Data Sources: MEDLINE, Embase, and Cochrane Library databases from inception to June 1, 2022, without language restriction.Study Selection: Randomized clinical trials (RCTs) comparing the effects of ticagrelor DAPT or ticagrelor monotherapy vs aspirin on saphenous vein graft failure.Data Extraction and Synthesis: Individual patient data provided by each trial were synthesized into a combined data set for independent analysis. Multilevel logistic regression models were used.Main Outcomes and Measures: The primary analysis assessed the incidence of saphenous vein graft failure per graft (primary outcome) in RCTs comparing ticagrelor DAPT with aspirin. Secondary outcomes were saphenous vein graft failure per patient and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events. A supplementary analysis included RCTs comparing ticagrelor monotherapy with aspirin.Results: A total of 4 RCTs were included in the meta-analysis, involving 1316 patients and 1668 saphenous vein grafts. Of the 871 patients in the primary analysis, 435 received ticagrelor DAPT (median age, 67 years [IQR, 60-72 years]; 65 women [14.9%]; 370 men [85.1%]) and 436 received aspirin (median age, 66 years [IQR, 61-73 years]; 63 women [14.5%]; 373 men [85.5%]). Ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure (11.2%) per graft than was aspirin (20%; difference, -8.7% [95% CI, -13.5% to -3.9%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001) and was associated with a significantly lower incidence of saphenous vein graft failure per patient (13.2% vs 23.0%, difference, -9.7% [95% CI, -14.9% to -4.4%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001). Ticagrelor DAPT (22.1%) was associated with a significantly higher incidence of BARC type 2, 3, or 5 bleeding events than was aspirin (8.7%; difference, 13.3% [95% CI, 8.6% to 18.0%]; OR, 2.98 [95% CI, 1.99 to 4.47]; P < .001), but not BARC type 3 or 5 bleeding events (1.8% vs 1.8%, difference, 0% [95% CI, -1.8% to 1.8%]; OR, 1.00 [95% CI, 0.37 to 2.69]; P = .99). Compared with aspirin, ticagrelor monotherapy was not significantly associated with saphenous vein graft failure (19.3% vs 21.7%, difference, -2.6% [95% CI, -9.1% to 3.9%]; OR, 0.86 [95% CI, 0.58 to 1.27]; P = .44) or BARC type 2, 3, or 5 bleeding events (8.9% vs 7.3%, difference, 1.7% [95% CI, -2.8% to 6.1%]; OR, 1.25 [95% CI, 0.69 to 2.29]; P = .46).Conclusions and Relevance: Among patients undergoing coronary artery bypass graft surgery, adding ticagrelor to aspirin was associated with a significantly decreased risk of vein graft failure. However, this was accompanied by a significantly increased risk of clinically important bleeding. [ABSTRACT FROM AUTHOR]

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: Caliskan, Etem^1,2 (AUTHOR), Sandner, Sigrid³ (AUTHOR), Misfeld, Martin⁴ (AUTHOR), Aramendi, Jose⁵ (AUTHOR), Salzberg, Sacha P.⁶ (AUTHOR), Choi, Yeong-Hoon⁷ (AUTHOR), Satishchandran, Vilas⁸ (AUTHOR), Iyer, Geeta⁸ (AUTHOR), Perrault, Louis P.⁹ (AUTHOR), Böning, Andreas¹⁰ (AUTHOR), Emmert, Maximilian Y.^1,2 (AUTHOR) emmert@dhzb.de

المصدر: Journal of Cardiothoracic Surgery. 10/15/2019, Vol. 14 Issue 1, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *CORONARY artery bypass, *SAPHENOUS vein, *ARTERIAL grafts, *RADIAL artery, *VASCULAR endothelium

مستخلص: Background: Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures.Methods: This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft.Discussion: This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level).Trial Registration: ClinicalTrials.gov NCT02922088 . Registered October 3, 2016.Ethics and Dissemination: The regional ethics committees have approved the registry. Results will be submitted for publication. [ABSTRACT FROM AUTHOR]

المؤلفون: Sigrid Sandner, Catherine J Pachuk, Etem Caliskan, Maximilian Y. Emmert, Thomas Aschacher, Milan Milojevic

المساهمون: University of Zurich, Sandner, Sigrid E, Cardiothoracic Surgery

المصدر: Minerva Cardioangiologica, 68(5), 480-488. Edizioni Minerva Medica

مصطلحات موضوعية: medicine.medical_specialty, Bypass grafting, Saphenous vein graft, Vein graft, 610 Medicine & health, 030204 cardiovascular system & hematology, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, 0302 clinical medicine, Preservation solutions, Humans, Medicine, Saphenous Vein, 030212 general & internal medicine, Coronary Artery Bypass, Vascular Patency, business.industry, Cabg surgery, 11359 Institute for Regenerative Medicine (IREM), Blood Vessel Prosthesis, Surgery, Vascular endothelium, Functional integrity, surgical procedures, operative, medicine.anatomical_structure, cardiovascular system, Endothelium, Vascular, Cardiology and Cardiovascular Medicine, business, Artery

الوصف: The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG). In light of this further research must be aimed at the development of strategies to optimize SVG patency and thereby improve both short- and long-term outcomes of CABG surgery. SVG patency in large part depends on the protection of the structural and functional integrity of the vascular endothelium at the time of conduit harvesting, including optimal storage conditions to prevent endothelial damage. This review provides an overview of currently available storage and preservation solutions, including novel endothelial damage inhibitors, and their role in mitigating endothelial damage and vein graft failure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1f58d5e1000408a0f0804d0b935ec508Test
https://doi.org/10.23736/s0026-4725.20.05234-2Test

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