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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Optimal Conduit Diameter Selection in Coronary Bypass Grafting Using Saphenous Vein
Malgorzata Maggie Szpytma1, Robert A Baker2, Damian Gimpel1
1Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia.
Insights
Larger saphenous vein grafts (SVGs) greater than 4 mm in diameter were linked to decreased long-term survival after coronary artery bypass grafting (CABG). This finding suggests graft size is a critical factor in CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Graft Patency Research
- Clinical Outcomes Analysis
Background:
- Long-term saphenous vein graft (SVG) patency after coronary artery bypass grafting (CABG) is influenced by several factors.
- These include harvesting technique, coronary stenosis severity, and target vessel characteristics.
Purpose of the Study:
- To investigate the relationship between saphenous vein graft diameter and long-term patient survival following CABG.
Main Methods:
- A cohort of 3,797 patients undergoing primary CABG between 2000 and 2017 were categorized by SVG diameter: small (<3.5 mm), medium (3.5-4 mm), and large (>4 mm).
- Survival data were analyzed using Kaplan-Meier analysis and Cox proportional hazard models, adjusted for preoperative variables.
Main Results:
- Analysis of 3,797 patients with a median follow-up of 7.6 years revealed 1,377 deaths.
- Saphenous vein grafts larger than 4 mm were associated with significantly lower adjusted survival rates within the first 4 years post-surgery (HR 1.48, p=0.026).
Conclusions:
- Vein graft diameter exceeding 4 mm is associated with reduced long-term survival after coronary artery bypass grafting.
- Graft size should be considered a significant factor in predicting CABG outcomes.
Background:
Predictors of long-term saphenous vein graft (SVG) patency following coronary artery bypass grafting (CABG) include harvesting technique, degree of proximal coronary stenosis, and target vessel diameter and runoff. The objective of this study was to evaluate the association between vein graft diameter and long-term survival.
Methods:
Patients undergoing primary CABG (2000-2017) at Flinders Medical Centre, Adelaide, Australia, were categorised into three groups according to average SVG diameter (<3.5 mm [small], 3.5-4 mm [medium], >4 mm [large]). Survival data was obtained from the Australian Institute of Health and Welfare National Death Index. To determine the association of SVG diameter with long-term survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables associated with survival.
Results:
Vein graft diameter was collected in 3,797 patients. Median follow-up time was 7.6 years (interquartile range, 3.9-11.8) with 1,377 deaths. SVG size >4 mm was associated with lower rates of adjusted survival up to 4 years postoperatively (hazard ratio 1.48; 95% confidence interval 1.05-2.1; p=0.026).
Conclusions:
Vein graft diameter >4mm was found to be associated with lower rates of survival following CABG.
