• Daniel J Goldstein, Helena L Chang, Michael J Mack, Pierre Voisine, James S Gammie, Mary E Marks, Alexander Iribarne, Yuliya Vengrenyuk, Samantha Raymond, Bradley S Taylor, François Dagenais, Gorav Ailawadi, ChuMichael W AMWADivision of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada., J Michael DiMaio, Jagat Narula, Ellen G Moquete, Karen O'Sullivan, Judson B Williams, Juan A Crestanello, Vincent Scavo, John D Puskas, Michael A Acker, Marc Gillinov, Annetine C Gelijns, Patrick T O'Gara, Alan J Moskowitz, John H Alexander, and Emilia Bagiella.
• Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY.
• J. Thorac. Cardiovasc. Surg. 2024 May 1; 167 (5): 17821792.e51782-1792.e5.

BackgroundDiffuse intimal hyperplasia and graft irregularity adversely affect the long-term patency of saphenous vein grafts (SVGs) and clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). The VEST trial evaluated the efficacy of external graft support in limiting the development of intimal hyperplasia (IH) at 1 year postsurgery. In the present secondary analysis, we explored the associations between graft disease and IH and clinical events. We also examined risk factors for early graft occlusion.MethodsVEST is a within-patient randomized, multicenter trial that enrolled 224 patients with multivessel coronary disease undergoing CABG surgery, of whom 203 were evaluated by 1 year postsurgery. Intimal hyperplasia, lumen uniformity, graft stenosis, and graft perfusion were measured by intravascular ultrasound and angiography. Major cardiac and cerebrovascular events (MACCE; including death, myocardial infarction, stroke, and revascularization) were recorded over a median follow-up of 3 years.ResultsWorse lumen uniformity, greater stenosis, and worse graft perfusion were associated with higher IH values and an increased incidence of clinical events. Consistent with previous findings, we identified endoscopic vein harvesting, female sex, and transit time flow measurement of pulsatility index and flow as risk factors for SVG occlusion during the first year postsurgery.ConclusionsIn this secondary analysis of the VEST trial, we observed an association between intimal hyperplasia area and clinical measures of SVG disease at 1 year postsurgery. More severe SVG disease and larger areas of IH were associated with a higher incidence of 3-year MACCE. Ongoing follow-up to 5 years will further elucidate the impact of SVG disease on long-term clinical outcomes of CABG.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

22 keywords...

hide…