Haime Miguel, McLean Robert R, Kurgansky Katherine E, Emmert Maximilian Y, Kosik Nicole, Nelson Constance, Gaziano Michael J, Cho Kelly, Gagnon David R
a VA Boston Healthcare System , Harvard Medical School , West Roxbury , MA , USA.
b Hebrew SeniorLife , Institute for Aging Research , Roslindale , MA , USA.
Expert Rev Cardiovasc Ther. 2018 Dec;16(12):963-970. doi: 10.1080/14779072.2018.1532289. Epub 2018 Oct 14.
Saphenous vein grafts (SVGs) remain the most often used conduits for coronary bypass grafting (CABG). Progressive intimal hyperplasia contributes to vein-graft disease and vein-graft failure (VGF). We compared the impact of intraoperative preservation of SVGs in a storage solution (DuraGraft®) versus heparinized saline on VGF-related outcomes after CABG.
From 1996 to 2004, 2436 patients underwent isolated CABG with ≥ 1 SVG. SVGs were consecutively treated with DuraGraft in 1036 patients (2001-2004) and heparinized saline in 1400 patients (1996-1999). Short- (< 30 days) and long-term (≥ 1000 days) outcomes were assessed using repeat revascularization (primary end point), and major adverse cardiac events (MACE) consisting of the composite of death, nonfatal myocardial infarction, or repeat revascularization.
Mean follow-up in the DuraGraft group was 8.5 ± 4.2 years and 9.9 ± 5.6 years in controls. Short-term event rates were low and generally did not differ between groups. DuraGraft was associated with a 45% lower occurrence of nonfatal myocardial infarction after 1000 days (hazard ratio 0.55, 95% CI 0.41-0.74; P < 0.0001). There was 35% and 19% lower long-term risk for revascularization (HR 0.65, 95% CI 0.44-0.97; P = 0.037) and MACE (HR 0.81, 95% CI 0.70-0.94; P = 0.0051), respectively, after DuraGraft. Mortality was comparable between both groups at 1, 5, and 10 years. There was no statistically significant association between DuraGraft exposure and time to death starting at 30 or 1000 days (HR 0.91, 95% CI 0.76-1.09; P = 0.29).
In this study, intraoperative treatment of SVGs with DuraGraft was associated with a lower risk of long-term adverse events suggesting that efficient intraoperative SVG treatment may reduce VGF-related complications post-CABG. These data warrant randomized clinical trials to validate these findings.
大隐静脉移植物（SVG）仍然是冠状动脉旁路移植术（CABG）中最常用的血管移植物。内膜增生进展会导致静脉移植物病变和静脉移植物失败（VGF）。我们比较了术中在储存溶液（DuraGraft®）中保存SVG与肝素盐水对CABG术后VGF相关结局的影响。
1996年至2004年，2436例患者接受了至少1根SVG的单纯CABG手术。1036例患者（2001 - 2004年）的SVG连续用DuraGraft处理，1400例患者（1996 - 1999年）的SVG用肝素盐水处理。使用再次血运重建（主要终点）以及由死亡、非致命性心肌梗死或再次血运重建组成的主要不良心脏事件（MACE）评估短期（<30天）和长期（≥1000天）结局。
DuraGraft组的平均随访时间为8.5±4.2年，对照组为9.9±5.6年。短期事件发生率较低，且两组之间一般无差异。DuraGraft与1000天后非致命性心肌梗死发生率降低45%相关（风险比0.55，95%CI 0.41 - 0.74；P<0.0001）。DuraGraft处理后，血运重建的长期风险降低35%（HR 0.65，95%CI 0.44 - 0.97；P = 0.037），MACE的长期风险降低19%（HR 0.81，95%CI 0.70 - 0.94；P = 0.0051）。两组在1年、5年和10年时的死亡率相当。从30天或1000天开始，DuraGraft暴露与死亡时间之间无统计学显著关联（HR 0.91，95%CI 0.76 - 1.09；P = 0.29）。
在本研究中，术中用DuraGraft处理SVG与较低的长期不良事件风险相关，提示有效的术中SVG处理可能降低CABG术后VGF相关并发症。这些数据需要进行随机临床试验以验证这些发现。
