Relationship between intra-operative vein graft treatment with DuraGraft® or saline and clinical outcomes after coronary artery bypass grafting

• Published in: Expert review of cardiovascular therapy Vol. 16; no. 12; p. 963
• Main Authors: Haime, Miguel, McLean, Robert R, Kurgansky, Katherine E, Emmert, Maximilian Y, Kosik, Nicole, Nelson, Constance, Gaziano, Michael J, Cho, Kelly, Gagnon, David R
• Format: Journal Article
• Language: English
• Published: England 02.12.2018
• Subjects: Adult; Aged; Aged, 80 and over; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction - epidemiology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proportional Hazards Models; Retrospective Studies; Saphenous Vein - transplantation; Treatment Outcome; patency; vein graft failure; repeat revascularization; CABG; myocardial infarction
• ISSN: 1744-8344
• DOI: 10.1080/14779072.2018.1532289

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.