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Comparison of alternate preparative techniques on wall thickness in coronary artery bypass grafts: The HArVeST randomized controlled trial

Authors
 Gianni D Angelini  ;  Tom Johnson  ;  Lucy Culliford  ;  Gavin Murphy  ;  Kate Ashton  ;  Tracy Harris  ;  Julia Edwards  ;  Gemma Clayton  ;  Yongcheol Kim  ;  Andrew C Newby  ;  Barney C Reeves  ;  Chris A Rogers 
Citation
 JOURNAL OF CARDIAC SURGERY, Vol.36(6) : 1985-1995, 2021-06 
Journal Title
JOURNAL OF CARDIAC SURGERY
ISSN
 0886-0440 
Issue Date
2021-06
MeSH
Coronary Artery Bypass* ; Humans ; Saphenous Vein* / diagnostic imaging ; Tissue and Organ Harvesting ; Ultrasonography ; Vascular Patency
Keywords
coronary artery bypass surgery ; distention pressure ; pedicle fat ; randomized controlled trial ; saphenous vein graft
Abstract
Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jocs.15477
DOI
10.1111/jocs.15477
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yongcheol(김용철) ORCID logo https://orcid.org/0000-0001-5568-4161
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188222
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