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Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement
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Intimal hyperplasia, saphenous vein graft disease, and clinical outcomes: Insights from the CTSN VEST randomized

Daniel J Goldstein1, Helena L Chang2, Michael J Mack3

  • 1Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY.

The Journal of Thoracic and Cardiovascular Surgery
|December 9, 2022
PubMed

Insights

Intimal hyperplasia in saphenous vein grafts (SVGs) is linked to worse graft disease and more cardiac events after coronary artery bypass grafting (CABG). This impacts long-term patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Biology
  • Clinical Trials

Background:

  • Saphenous vein grafts (SVGs) are crucial for coronary artery bypass grafting (CABG), but intimal hyperplasia (IH) and graft irregularity reduce their long-term effectiveness.
  • The VEST trial investigated external graft support to mitigate IH development at one year post-surgery.
  • This secondary analysis examines the relationship between graft disease, IH, and clinical events, alongside risk factors for early graft occlusion.

Purpose of the Study:

  • To explore the associations between graft disease, intimal hyperplasia (IH), and clinical events in patients undergoing coronary artery bypass grafting (CABG).
  • To identify risk factors contributing to early saphenous vein graft (SVG) occlusion.

Main Methods:

  • A secondary analysis of the VEST trial, a within-patient randomized multicenter study involving 224 patients undergoing CABG.
  • Intravascular ultrasound and angiography were used to assess IH, lumen uniformity, stenosis, and graft perfusion at one year post-surgery.
  • Major adverse cardiac and cerebrovascular events (MACCE) were recorded over a median follow-up of three years.

Main Results:

  • Poorer lumen uniformity, increased graft stenosis, and impaired graft perfusion correlated with higher IH values and more clinical events.
  • Endoscopic vein harvesting, female sex, and specific transit time flow measurements were identified as risk factors for SVG occlusion within the first year.
  • A significant association was found between IH area and clinical measures of SVG disease at one year.

Conclusions:

  • Increased intimal hyperplasia and more severe saphenous vein graft disease are linked to a higher incidence of major adverse cardiac and cerebrovascular events (MACCE) at three years post-coronary artery bypass grafting (CABG).
  • Further follow-up to five years is needed to fully understand the long-term impact of SVG disease on clinical outcomes.
Abstract

Keywords:
CABGintimal hyperplasiasaphenous vein graft disease

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