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Updated: Nov 13, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Comparison of alternate preparative techniques on wall thickness in coronary artery bypass grafts: The HArVeST
Gianni D Angelini1, Tom Johnson1, Lucy Culliford2
1Bristol Heart Institute, University of Bristol, Bristol, UK.
Insights
Low-pressure testing and preserving vein pedicle during coronary artery bypass grafting surgery (CABG) may improve graft patency. Low-pressure testing reduced hospital admissions, while pedicle harvesting increased initial complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) success relies on long-term graft patency.
- Early graft wall thickening negatively impacts patency.
- Minimizing high-pressure distension and preserving vein pedicle may reduce wall thickening.
Purpose of the Study:
- To compare the impact of high vs. low-pressure leak testing.
- To evaluate vein harvesting with vs. without pedicle preservation.
- To assess effects on graft wall thickness and lumen diameter post-CABG.
Main Methods:
- Factorial randomized controlled trial at a single center.
- Compared high vs. low-pressure leak testing.
- Compared vein harvesting with vs. without pedicle preservation.
Main Results:
- Low-pressure testing tended to yield thinner vessel walls (p=0.066).
- Pedicle harvesting with high-pressure testing also tended to reduce wall thickness (p=0.066).
- Low-pressure testing correlated with fewer hospital admissions (p=0.0008).
Conclusions:
- Conventional saphenous vein graft preparation with low-pressure distension and pedicle harvesting resulted in similar graft wall thickness at 12 months.
- Low-pressure testing was associated with fewer adverse events.
- Pedicle harvesting increased complications during the initial hospital stay.
Background:
The success of coronary artery bypass grafting surgery (CABG) is dependent on long-term graft patency, which is negatively related to early wall thickening. Avoiding high-pressure distension testing for leaks and preserving the surrounding pedicle of fat and adventitia during vein harvesting may reduce wall thickening.
Methods:
A single-centre, factorial randomized controlled trial was carried out to compare the impact of testing for leaks under high versus low pressure and harvesting the vein with versus without the pedicle in patients undergoing CABG. The primary outcomes were graft wall thickness, as indicator of medial-intimal hyperplasia, and lumen diameter assessed using intravascular ultrasound after 12 months.
Results:
Ninety-six eligible participants were recruited. With conventional harvest, low-pressure testing tended to yield a thinner vessel wall compared with high-pressure (mean difference [MD; low minus high] -0.059 mm, 95% confidence interval (CI) -0.12, +0.0039, p = .066). With high pressure testing, veins harvested with the pedicle fat tended to have a thinner vessel wall than those harvested conventionally (MD [pedicle minus conventional] -0.057 mm, 95% CI: -0.12, +0.0037, p = .066, test for interaction p = .07). Lumen diameter was similar across groups (harvest comparison p = .81; pressure comparison p = .24). Low-pressure testing was associated with fewer hospital admissions in the 12 months following surgery (p = .0008). Harvesting the vein with the pedicle fat was associated with more complications during the index admission (p = .0041).
Conclusions:
Conventional saphenous vein graft preparation with low-pressure distension and harvesting the vein with a surrounding pedicle yielded similar graft wall thickness after 12 months, but low pressure was associated with fewer adverse events.
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