Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery: Follow-up From PREVENT IV Randomized Clinical Trial

Abstract

Inpatient Register and the Swedish National Register for Vascular Surgery (Swedvasc). Associations were estimated with Cox proportional hazards models. The cohorts included 35,550 women and 42,596 men, aged 46 to 84 years. During follow-up, AAA was identified in 199 women and 958 men. The incidence of AAA per 100,000 person-years was 76 among men who never smoked and 136 among women who currently smoked. Regarding AAA risk, women were more sensitive to current smoking (P interaction ¼ .002). Compared with never smokers, the hazard ratio (HR) for AAA in current smokers with more than 20 pack-years was 10.97 (95% confidence interval [CI], 7.41-16.26) among women and 6.55 (95% CI, 5.36-7.99) among men. Following smoking cessation, women had a more rapid decline in excess risk (P interaction < 0.001). The risk was halved after 11 years (HR, 0.51; 95% CI, 0.32-0.81) among women and after 23 years (HR, 0.50; 95% CI, 0.42-0.60) among men.Comment: The data suggests that although women are not generally included in AAA screening programs, women who smoke have a higher incidence of AAA than men who never smoked. It also appears that women are more sensitive to current tobacco exposure with regard to AAA risk and that smoking cessation decreasing the risk of AAA twice as quickly among women than men. It therefore appears that targeted screening for AAA in women should be investigated further with both screening based studies and cost-effectiveness analyses.

Disconnect Between Vein Graft Failure and Clinical Events After Coronary Artery Bypass Graft Surgery

“…1 In this issue of Circulation, Hess and colleagues 2 report insights from the PREVENT IV study on VGF after CABG surgery. This is the 11th study published in a major journal reporting results of the PREVENT IV study [3][4][5][6][7][8][9][10][11][12] and involves the same patients. The angiographic results were analyzed from different clinical angles.…”

Do storage solutions protect endothelial function of arterialized vein graft in an experimental rat model?

“…The GALA solution (Glutathione, Lascorbique acid, L-arginine and glucose; pH = 7.4), being widely recognized in this purpose; its effects compared to other solutions (saline and autologous blood with added heparin) maintained the endothelial function and structural viability of the grafts for 1 to 24 h of storage [10]. A sub study of the PREVENT IV randomized trial demonstrated that buffered saline solution had lower vein graft failure rate studied by angiography 12 to 18 months after surgery and better clinical outcomes compared to saline or autologous blood solutions [11].…”

Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?

“…Endothelial integrity is critical to avoid early graft occlusion. During a CABG procedure, there is a routine time interval—usually 1 to 2 hours long—between vein harvesting and SVG to coronary artery anastomosis conduction, when the graft is kept in a storage solution 1,7,8 …”

“…This interval may be critical for endothelial integrity and subsequent patency of the graft. Therefore, graft patency partially depends on the composition and temperature of the storage solution 1,7,8 . There is an endless debate as to which storage solution is optimal.…”