부산대학교 도서관

Key Words CABG; external bypass stent; Fitzgibbon patency; intimal hyperplasia; long-term patency; venous grafts Abstract Objectives Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease. Methods A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years. Results Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001). Conclusions Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown. Abbreviations and Acronyms CABG, coronary artery bypass grafting; CTA, computed tomography angiography; EEM, external elastic media; EVH, endoscopic vein harvesting; FPS, Fitzgibbon Patency Scale; ICC, intraclass correlation coefficient; IVUS, intravascular ultrasound; MACCE, major adverse cardiac and cerebrovascular events; MLD, minimal lumen diameter; SVG, saphenous vein graft Author Affiliation: (i) Department of Cardiothoracic Surgery, University Hospitals Bristol, Bristol, United Kingdom (j) Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom (k) Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom (l) Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (m) Herzzentrum Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany (n) Department of Cardiothoracic Surgery, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau bei Berlin, Brandenburg, Germany (o) Department of Cardiothoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria (p) Department of Cardiothoracic Surgery, Medizinische Universität Wien, Wien, Vienna, Austria (q) Department of Cardiothoracic Surgery, Rambam Medical Center, Haifa, Israel (r) Department of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany (s) Department of Cardiothoracic Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany (t) Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (u) Justus-Liebig-University Gießen, Campus Kerckhoff, Bad Nauheim, Germany (v) German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Frankfurt/Main, Germany (w) Department of Cardiothoracic Surgery, Uniklinik Köln, Köln, Germany (x) Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, United Kingdom (y) Department of Cardiothoracic Surgery, Sheba Medical Center, Ramat Gan, Israel (a) Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (b) TechnoSTAT Ltd, Raanana, Israel (c) Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom (d) Department of Cardiothoracic Surgery, University Hospitals Bristol, Bristol, United Kingdom (e) Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom (f) Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom (g) Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (h) Herzzentrum Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany * Address for reprints: Ivar Friedrich, MD, Herzzentrum Trier, Nordallee 1, 54292 Trier, Germany. Article History: Received 9 November 2020; Revised 28 March 2021; Accepted 29 March 2021 (footnote) The VEST III Study was funded by Vascular Graft Solutions (Israel). The investigators had full academic freedom. (footnote) Clinical Trial Registry Number: NCT02511834. Institutional Review Board Information: UK - REC 15/SC/0311, July 9, 2015, Germany - CIV-15-04-013504, September 8, 2015, Austria - Vienna EC 1330/2015, August 11, 2015, Innsbruck EC AN2016-0036 359/4.11, August 8, 2016, Israel - Rambam 0244-15-RMB, August 12, 2015, Sheba 2357-15-SMC, December 17, 2015. (footnote)* Umberto Benedetto, MD,d Hunaid Vohra, MD,d Mohamad Nidal Bittar, MD,e Amal Bose, MD,e Marius Berman, MD,f Rajesh Kharbanda, MD,g Alexandros Paraforos, MD,h Leonid, Ladyshenskij, MD,i Nikolaos Bonaros, MD,j Thomas Schachner, MD,j Sigrid Sandner, MD,k Philipp Angleitner, MD,k Gil Bolotin, MD,l Stephan Jacobs, MD,m Matthias Thielmann, MD,n Daniel Wendt, MD,n Yeong-Hoon Choi, MD,o,p,q,r Oliver Liakopoulos, MD,o,p,q,r Sunil Ohri, MD,s and Alexander Lipey, MDt. dDepartment of Cardiothoracic Surgery, University Hospitals Bristol, Bristol, United Kingdom; eDepartment of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom; fDepartment of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom; gDepartment of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; hHerzzentrum Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany; iDepartment of Cardiothoracic Surgery, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Brandenburg, Germany; jDepartment of Cardiothoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; kDepartment of Cardiothoracic Surgery, Medizinische Universität Wien, Vienna, Austria; lDepartment of Cardiothoracic Surgery, Rambam Medical Center, Haifa, Israel; mDepartment of Cardiothoracic Surgery, German Heart Centre Berlin, Berlin, Germany; nDepartment of Cardiothoracic Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany; oDepartment of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; pJustus-Liebig-University Gießen, Campus Kerckhoff, Bad Nauheim, Germany; qGerman Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Frankfurt/Main, Germany; rDepartment of Cardiothoracic Surgery, Uniklinik Köln, Germany; sDepartment of Cardiothoracic Surgery, University Hospital Southampton, Southampton, United Kingdom; and tDepartment of Cardiothoracic Surgery, Sheba Medical Center, Ramat Gan, Israel. Byline: David P. Taggart, MD (a), Yulia Gavrilov, PhD (b), George Krasopoulos, MD (c), Cha Rajakaruna, MD (d), Joseph Zacharias, MD (e), Ravi De Silva, MD (f), Keith M. Channon, MD (g), Thomas Gehrig, MD (h), Terrence John Donovan, MD (h), Ivar Friedrich, MD [i.friedrich@bk-trier.de] (h,*), Umberto Benedetto, MD (i), Hunaid Vohra, MD (i), Mohamad Nidal Bittar, MD (j), Amal Bose, MD (j), Marius Berman, MD (k), Rajesh Kharbanda, MD (l), Alexandros Paraforos, MD (m), Leonid Ladyshenskij, MD (n), Nikolaos Bonaros, MD (o), Thomas Schachner, MD (o), Sigrid Sandner, MD (p), Philipp Angleitner, MD (p), Gil Bolotin, MD (q), Stephan Jacobs, MD (r), Matthias Thielmann, MD (s), Daniel Wendt, MD (s), Yeong-Hoon Choi, MD (t,u,v,w), Oliver Liakopoulos, MD (t,u,v,w), Sunil Ohri, MD (x), Alexander Lipey, MD (y)