Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 26;13(1):122.
doi: 10.1186/s13019-018-0800-z.

Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein grafts

Mikael Janiec  1   2 , Örjan Friberg  3 , Stefan Thelin  4   5
Affiliations

Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein grafts

Mikael Janiec et al. J Cardiothorac Surg. .

Abstract

Background: Coronary artery bypass grafting (CABG) using saphenous vein grafts (SVG) is vitiated by poor long-term patency of the vein grafts. Pedicled SVG harvested with the "no-touch" (NT) technique have demonstrated improved patency and could confer better outcomes. We aim to compare long-term results after CABG where NT or conventional technique was used for vein graft harvesting in a hypothesis-generating registry-based study.

Methods: Two propensity score matched cohorts (1349 patients) undergoing CABG with veins harvested with NT (NTT) or conventional (CT) technique in Sweden over the period 2005-2015 were used to compare long-term outcomes. Mortality, postoperative incidence of coronary angiography and need for reintervention was recorded and multivariable hazard ratios adjusted for risk factors were calculated.

Results: The mean follow-up time (SD) was 6.8 (3.3) years for NTT and 6.6 (3.2) years for CT. The adjusted hazard ratios for death, first angiography and need for reintervention for NTT patients were (95% CI) 0.97 (0.80-1.19), 0.76 (0.63-0.93), 0.91 (0.78-1.05), and 0.91 (0.71-1.17), respectively. Failed grafts were found in 43.2% of NTT patients and 53.6% of CT patients at angiography.

Conclusions: In this study NT grafting was associated with a lower risk for repeat angiography, however no difference could be observed for mortality and need for reintervention. The earlier reported improvements in patency of NT veins could possibly be reflected in an improved clinical outcome during the first 10 years after surgery.

Keywords: CABG; Coronary artery bypass grafting; No-touch; Pedicled vein grafts.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the regional Human Research Ethics Committee, Uppsala, Sweden.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patients. All CABG operated patients in Sweden between 2005 and 2015, aged 40 to 80 years old, without congenital malformations, were included in the study data base. We excluded redo operations, cases where no IMA was used or where graft information was missing, cases where single IMA was the only graft used, cases where arterial grafts other than the single IMA were used and cases where an endarterectomy or plasty was performed. CABG indicates coronary artery bypass grafting; IMA internal mammary artery; SVG saphenous vein graft
Fig. 2
Fig. 2
Survival, cumulative incidence of first angiography and first reintervention after CABG for the NT and C group. Tables of number of patients at risk are also shown
See this image and copyright information in PMC

References

    1. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629–638. doi: 10.1016/S0140-6736(13)60141-5. - DOI - PubMed
    1. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur J Cardiothorac Surg. 2014;46:517–592. doi: 10.1093/ejcts/ezu366. - DOI - PubMed
    1. Stone GW, Sabik JF, Serruys PW, Simonton CA, Genereux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left Main coronary artery disease. N Engl J Med. 2016;375:2223–2235. doi: 10.1056/NEJMoa1610227. - DOI - PubMed
    1. Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016;388:2743–2752. doi: 10.1016/S0140-6736(16)32052-9. - DOI - PubMed
    1. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation. 1998;97:916–931. doi: 10.1161/01.CIR.97.9.916. - DOI - PubMed

MeSH terms