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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
Venous external support enhanced coronary artery bypass grafting: a multicentric cohort experience
Luca Paolo Weltert1,2,3, Sigrid Sandner4, Paolo Centofanti5
1Department of Cardiac Surgery, European Hospital, Rome, Italy. lweltert@gmail.com.
Insights
Coronary artery bypass grafting (CABG) using VEST-supported saphenous vein grafts (SVG) shows promising short- to mid-term results. This technique is linked to significantly lower repeat revascularization rates compared to non-stented grafts.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Minimally Invasive Cardiac Surgery
Background:
- Saphenous vein grafts (SVGs) are crucial in coronary artery bypass grafting (CABG).
- External stenting of SVGs aims to improve graft patency and reduce revascularization needs.
- Evaluating outcomes of VEST-enhanced CABG is important for clinical practice.
Purpose of the Study:
- To assess short- and mid-term clinical outcomes of CABG using VEST-supported SVGs.
- To specifically evaluate the rate of repeat revascularization in VEST-enhanced grafts.
Main Methods:
- A multicenter study involving 397 patients undergoing CABG with at least one VEST-supported SVG.
- Patients underwent on-pump or off-pump CABG, with or without concomitant procedures.
- Follow-up for major adverse cardiac and cerebral events (MACCE) for a median of 24 months.
Main Results:
- 71.7% of SVGs received external stents.
- Freedom from MACCE at 5 years was 82.4%.
- Revascularization rates were significantly lower for VEST-stented SVGs (1.28%) compared to non-stented SVGs (4.32%).
Conclusions:
- VEST-enhanced CABG is feasible in routine practice, including complex cases.
- The technique is associated with low MACCE and very low target vessel revascularization rates.
- Most re-revascularizations occurred in non-grafted or non-VEST-enhanced territories.
Objectives:
This multicentric study evaluated short- and mid-term clinical outcomes, with specific focus on the need for repeat revascularization, in patients undergoing coronary artery bypass grafting (CABG) with VEST supported saphenous vein graft (SVG).
Methods:
A total of 397 patients underwent CABG in a three-center setting, with or without concomitant procedures, with at least one SVG supported with an external stent. Open vein harvesting was performed in 80.3% of patients. The majority (73.3%) of patients underwent on-pump CABG, 6.8% of patients had concomitant valve surgery, and the average number of grafts per patient was three. Patients were followed for major adverse cardiac and cerebral events (MACCE) for a median duration of 24 (1-101) months.
Results:
Overall, 469 of 654 SVG (71.7%) received external stents. Freedom from MACCE at 1, 3, and 5 years was 95.1% (SE 0.011), 85.4% (SE 0.021), and 82.4% (SE 0.030) respectively. Revascularization rates in territories which were grafted with a stented SV was low in general (1.28%) and statistically significantly lower than in territories grafted with a non-stented SVG (4.32%, p = 0.015). Arterially grafted territories confirmed low revascularization rates as well (0.9%).
Conclusions:
VEST-enhanced CABG is feasible and associated with low MACCE in real world routine practice which includes on and off pump CABG, sequential grafting, and concomitant surgery. Short- to mid-term clinical follow up suggests that VEST enhanced CABG is associated with very low target vessel revascularization rates, with most re-revascularization happening at non-grafted or non-VEST-enhanced grafted territories.
