TY - JOUR
T1 - Saphenous Vein Graft Failure
T2 - From Pathophysiology to Prevention and Treatment Strategies
AU - Xenogiannis, Iosif
AU - Zenati, Marco
AU - Bhatt, Deepak L.
AU - Rao, Sunil V.
AU - Rodés-Cabau, Josep
AU - Goldman, Steven
AU - Shunk, Kendrick A.
AU - Mavromatis, Kreton
AU - Banerjee, Subhash
AU - Alaswad, Khaldoon
AU - Nikolakopoulos, Ilias
AU - Vemmou, Evangelia
AU - Karacsonyi, Judit
AU - Alexopoulos, Dimitrios
AU - Burke, M. Nicholas
AU - Bapat, Vinayak N.
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
D.L.B. discloses the following relationships: advisory board: Cardax, CellPro-thera, Cereno Scientific, Elsevier Practice Update Cardiology, Janssen, Level Ex, Medscape Cardiology, MyoKardia, Novo Nordisk, PhaseBio, PLx Pharma, Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial [Self-Expanding Intra-Annular Versus Commercially Available Transcatheter Heart Valves in High and Extreme Risk Patients With Severe Aortic Stenosis], funded by St Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial [CENTERA THV System in Intermediate Risk Patients Who Have Symptomatic, Severe, Calcific, Aortic Stenosis], funded by Edwards), Contego Medical (Chair, PERFORMANCE 2 [Protection Against Emboli During Carotid Artery Stenting Using the Neuroguard IEP System]), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial [Edoxaban Compared to Standard Care After Heart Valve Replacement Using a Catheter in Patients With Atrial Fibrillation], funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial [Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran versus Triple Therapy With Warfarin in Patients with Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention] steering committee funded by Boehringer Ingelheim; AEGIS-II [ApoA-I Event Reducing in Ischemic Syndromes II] executive committee funded by CSL Behring), Belvoir Publications (editor-in-chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial [A Trial Comparing Cardiovascular Safety of Degarelix Versus Leuprolide in Patients With Advanced Prostate Cancer and Cardiovascular Disease], funded by Ferring Pharmaceuticals), Healthcare Made Practical (HMP) Global (editor-in-chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), K2P (co-chair, interdisciplinary curriculum), Level Ex, Medtelli-gence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies] operations committee, publications committee, steering committee, and USA national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); other: Clinical Cardiology (deputy editor), NCDR (National Cardiovascular Data Registry)-ACTION Registry Steering Committee (chair), VA CART (Veterans Affairs-Clinical Assessment Reporting and Tracking) Research and Publications Committee (chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Frac-tyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Lexicon, Lilly, Medtronic, MyoKardia, Novartis, Novo Nordisk, Owkin, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, The Medicines Company, 89Bio; Royalties: Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); site co-investigator: Abbott, Biotronik, Boston Scientific, CSI, St Jude Medical (now Abbott), Svelte; trustee: American College of Cardiology; unfunded research: FlowCo, Merck, Takeda. J.R.-C. received institutional research grants from Boston Scientific and Medtronic. K.A.S. discloses the following relationships: Abbott Vascular: MitraClip training; Boston Scientific: Lotus training; Cardiovascular Systems Inc: research/ research grants; Edwards Sapien training; Medtronic: CoreValve training; Per-cAssist: consultant with stock option compensation, Siemens Medical Systems: research/research grants; Svelte: research/research grants; Syntactx Data: Safety Monitoring Board; Terumo Consultant: fees/honoraria; TransAor-tic Medical, Inc: Consultant and Advisory Board member with stock option compensation. S.B. discloses the following relationships: Honoraria: Medtron-ic, Cordis, Kaneka, Livmor; Institutional Research Grants: BSC, Chiesi. K.A. discloses the following relationships: Consultant: Boston Scientific, Teleflex, CSI, LivaNova; Speaker: BSC, CSI. D.A. discloses the following relationships: lecturing honoraria/advisory board fees: AstraZeneca, Bayer, Boehringer In-gelheim, Pfizer, Medtronic, Biotronik, and Chiesi Hellas. M.N.B. discloses the following relationships: Shareholder: MHI Ventures, Egg Medical. V.N.B. discloses the following relationships: consultant: Boston Scientific, Medtornic, Abbott, Edwards Lifesciences. E.S.B. discloses the following relationships: consulting/speaker honoraria: Abbott Vascular, American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (board of directors), Control-Rad, CSI, Elsevier, GE Healthcare, InfraRedx, Medicure, Medtronic, Opsens, Siemens, and Teleflex; owner: Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health. The other authors report no conflicts.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/8/31
Y1 - 2021/8/31
N2 - Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short-and long-term outcomes and is preferred over SVG PCI, if technically feasible.
AB - Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short-and long-term outcomes and is preferred over SVG PCI, if technically feasible.
KW - coronary artery bypass graft surgery
KW - embolic protection devices
KW - no-reflow
KW - percutaneous coronary intervention
KW - prevention
KW - saphenous vein grafts
UR - http://www.scopus.com/inward/record.url?scp=85114092364&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114092364&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.120.052163
DO - 10.1161/CIRCULATIONAHA.120.052163
M3 - Article
C2 - 34460327
AN - SCOPUS:85114092364
SN - 0009-7322
VL - 144
SP - 728
EP - 745
JO - Circulation
JF - Circulation
IS - 9
ER -