Bristol Heart Institute, University of Bristol, Bristol, UK.
Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK.
J Card Surg. 2021 Jun;36(6):1985-1995. doi: 10.1111/jocs.15477. Epub 2021 Mar 12.
The success of coronary artery bypass grafting surgery (CABG) is dependent on long-term graft patency, which is negatively related to early wall thickening. Avoiding high-pressure distension testing for leaks and preserving the surrounding pedicle of fat and adventitia during vein harvesting may reduce wall thickening.
A single-centre, factorial randomized controlled trial was carried out to compare the impact of testing for leaks under high versus low pressure and harvesting the vein with versus without the pedicle in patients undergoing CABG. The primary outcomes were graft wall thickness, as indicator of medial-intimal hyperplasia, and lumen diameter assessed using intravascular ultrasound after 12 months.
Ninety-six eligible participants were recruited. With conventional harvest, low-pressure testing tended to yield a thinner vessel wall compared with high-pressure (mean difference [MD; low minus high] -0.059 mm, 95% confidence interval (CI) -0.12, +0.0039, p = .066). With high pressure testing, veins harvested with the pedicle fat tended to have a thinner vessel wall than those harvested conventionally (MD [pedicle minus conventional] -0.057 mm, 95% CI: -0.12, +0.0037, p = .066, test for interaction p = .07). Lumen diameter was similar across groups (harvest comparison p = .81; pressure comparison p = .24). Low-pressure testing was associated with fewer hospital admissions in the 12 months following surgery (p = .0008). Harvesting the vein with the pedicle fat was associated with more complications during the index admission (p = .0041).
Conventional saphenous vein graft preparation with low-pressure distension and harvesting the vein with a surrounding pedicle yielded similar graft wall thickness after 12 months, but low pressure was associated with fewer adverse events.
冠状动脉旁路移植术（CABG）的成功取决于移植物的长期通畅性，而通畅性与早期壁增厚呈负相关。避免对渗漏进行高压扩张测试，并在静脉采集过程中保留周围的脂肪和外膜蒂，可以减少壁增厚。
进行了一项单中心、析因随机对照试验，比较了在 CABG 患者中对渗漏进行高压与低压测试以及带蒂与不带蒂采集静脉对移植物壁厚度（作为中膜-内膜增生的指标）和 12 个月后血管内超声评估的管腔直径的影响。
共招募了 96 名符合条件的参与者。与传统采集相比，低压测试倾向于使血管壁更薄（低压与高压之间的平均差异[MD] -0.059mm，95%置信区间[CI] -0.12，+0.0039，p=0.066）。在高压测试时，与传统采集相比，带蒂脂肪采集的静脉壁更薄（蒂与传统采集之间的 MD [pedicle minus conventional] -0.057mm，95% CI：-0.12，+0.0037，p=0.066，检验交互作用 p=0.07）。各组之间的管腔直径相似（采集比较 p=0.81；压力比较 p=0.24）。低压测试与术后 12 个月内住院次数减少相关（p=0.0008）。带蒂脂肪采集与住院期间发生更多并发症相关（p=0.0041）。
在 12 个月后，传统的大隐静脉移植物准备采用低压扩张和带蒂采集静脉，移植物壁厚度相似，但低压与较少的不良事件相关。
