Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: One-year graft failure and five-year outcomes from the project of Ex-vivo vein graft engineering via transfection (PREVENT) IV trial

Rajendra H. Mehta, T. Bruce Ferguson, Renato D. Lopes, Gail E. Hafley, Michael J. MacK, Nicholas T. Kouchoukos, C. Michael Gibson, Robert A. Harrington, Robert M. Califf, Eric D. Peterson, John H. Alexander

Research output: Contribution to journalArticlepeer-review

Abstract

Background-: Limited information exists on the intermediate-term graft patency and 5-year clinical outcomes of patients receiving saphenous vein grafts with multiple (m-SVG) versus single distal targets (s-SVG) during coronary artery bypass graft (CABG) surgery in the current era. Methods and Results-: We studied the association of the use of m-SVG versus s-SVG conduits with 1-year SVG failure (defined as ≥75% angiographic stenosis) and 5-year clinical events (death; death or myocardial infarction [MI]; and death, MI, or revascularization) in 3014 patients undergoing their first CABG surgery enrolled in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV. Of 3014 patients enrolled in PREVENT IV, 1045 (34.7%) had ≥1 m-SVGs during CABG. Vein graft failure at 1-year was higher for m-SVG compared with s-SVG (adjusted odds ratio 1.24, 95% confidence interval 1.03 to 1.48). At 5 years, the adjusted composite of death, MI (including perioperative MI), or revascularization (hazard ratio 1.15, 95% confidence interval 1.00 to 1.31) and death or MI (hazard ratio 1.21, 95% confidence interval 1.03 to 1.43) were significantly higher in patients receiving m-SVGs. Conclusions-: In patients undergoing first CABG surgery, the use of m-SVG was associated with a higher 1-year vein graft failure rate and trends toward worse clinical outcomes. Additional studies are needed to better understand the most appropriate conduit to improve long-term graft patency and clinical outcomes of patients undergoing CABG surgery. In the meantime, these data should encourage the use of s-SVG over m-SVG when feasible.

Original languageEnglish (US)
Pages (from-to)280-288
Number of pages9
JournalCirculation
Volume124
Issue number3
DOIs
StatePublished - Jul 19 2011
Externally publishedYes

Keywords

  • bypass grafts
  • coronary artery bypass grafting
  • outcomes
  • vascular patency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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