Relationship between intra-operative vein graft treatment with DuraGraft® or saline and clinical outcomes after coronary artery bypass grafting
| Autor: | Nicole M Kosik, Maximilian Y. Emmert, Michael Gaziano, David R. Gagnon, Katherine E. Kurgansky, Robert R. McLean, Kelly Cho, Constance Nelson, Miguel Haime |
|---|---|
| Přispěvatelé: | University of Zurich, Haime, Miguel |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male CABG myocardial infarction patency repeat revascularization vein graft failure medicine.medical_specialty Intimal hyperplasia Bypass grafting medicine.medical_treatment Myocardial Infarction 610 Medicine & health Vein graft 030204 cardiovascular system & hematology 2705 Cardiology and Cardiovascular Medicine 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal Medicine medicine Clinical endpoint Humans Saphenous Vein Myocardial infarction Coronary Artery Bypass Saline Aged Proportional Hazards Models Retrospective Studies Aged 80 and over business.industry 11359 Institute for Regenerative Medicine (IREM) General Medicine Middle Aged medicine.disease 10020 Clinic for Cardiac Surgery Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure 2724 Internal Medicine 030220 oncology & carcinogenesis Female Cardiology and Cardiovascular Medicine business Mace Follow-Up Studies Artery |
| Zdroj: | Expert Review of Cardiovascular Therapy. 16:963-970 |
| ISSN: | 1744-8344 1477-9072 2001-2004 |
| Popis: | Saphenous vein grafts (SVGs) remain the most often used conduits for coronary bypass grafting (CABG). Progressive intimal hyperplasia contributes to vein-graft disease and vein-graft failure (VGF). We compared the impact of intraoperative preservation of SVGs in a storage solution (DuraGraft®) versus heparinized saline on VGF-related outcomes after CABG.From 1996 to 2004, 2436 patients underwent isolated CABG with ≥ 1 SVG. SVGs were consecutively treated with DuraGraft in 1036 patients (2001-2004) and heparinized saline in 1400 patients (1996-1999). Short- ( 30 days) and long-term (≥ 1000 days) outcomes were assessed using repeat revascularization (primary end point), and major adverse cardiac events (MACE) consisting of the composite of death, nonfatal myocardial infarction, or repeat revascularization.Mean follow-up in the DuraGraft group was 8.5 ± 4.2 years and 9.9 ± 5.6 years in controls. Short-term event rates were low and generally did not differ between groups. DuraGraft was associated with a 45% lower occurrence of nonfatal myocardial infarction after 1000 days (hazard ratio 0.55, 95% CI 0.41-0.74; P 0.0001). There was 35% and 19% lower long-term risk for revascularization (HR 0.65, 95% CI 0.44-0.97; P = 0.037) and MACE (HR 0.81, 95% CI 0.70-0.94; P = 0.0051), respectively, after DuraGraft. Mortality was comparable between both groups at 1, 5, and 10 years. There was no statistically significant association between DuraGraft exposure and time to death starting at 30 or 1000 days (HR 0.91, 95% CI 0.76-1.09; P = 0.29).In this study, intraoperative treatment of SVGs with DuraGraft was associated with a lower risk of long-term adverse events suggesting that efficient intraoperative SVG treatment may reduce VGF-related complications post-CABG. These data warrant randomized clinical trials to validate these findings. |
| Databáze: | OpenAIRE |
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