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Improving coronary artery bypass graft durability: use of the external saphenous vein graft support
Enrico Ferrari1, Ludwig von Segesser2, Denis Berdajs2
1Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland enricoferrari@bluewin.ch.
Insights
External support for saphenous vein grafts improves durability in coronary artery bypass grafting. The eSVS Mesh device prevents graft failure by reducing radial expansion and intimal hyperplasia, enhancing long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Vascular Grafts
Background:
- Coronary artery bypass grafting (CABG) is optimal for multivessel coronary artery disease.
- Saphenous vein grafts (SVGs) are common conduits but have poor long-term durability (75% occlusion at 10 years).
- Graft failure is linked to kinking, dilatation, and intimal hyperplasia.
Purpose of the Study:
- To introduce the eSVS Mesh device, an external support for saphenous vein grafts.
- To describe the surgical technique for applying the eSVS Mesh.
- To present preliminary clinical results on the efficacy of the eSVS Mesh.
Main Methods:
- The eSVS Mesh is a weft-knitted nitinol external support placed over the SVG.
- It is designed to prevent graft kinking, dilatation, and intimal hyperplasia.
- Surgical preparation and deployment technique are detailed.
Main Results:
- The eSVS Mesh reduces vein diameter by 15-20% to counteract radial expansion.
- It aims to suppress intimal hyperplasia induced by systemic blood pressure.
- Preliminary clinical outcomes are presented.
Conclusions:
- The eSVS Mesh offers a novel approach to enhance saphenous vein graft durability.
- External support may mitigate key failure mechanisms in vein grafts.
- Further clinical evaluation is warranted to confirm long-term benefits.
Abstract:
Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.
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