Luca Paolo Weltert1,2, Katia Audisio3, Alessandro Bellisaro4, Gianluca Bardi3, Roberto Flocco3, Ruggero De Paulis4, Paolo Centofanti3. 1. Heart Surgery Unit, European Hospital, 700, Via portuense, 00149, Rome, Italy. lweltert@gmail.com. 2. Department of Statistics, Saint Camillus International University of Health and Medical Sciences, 8, Via di Sant'Alessandro, 00131, Rome, Italy. lweltert@gmail.com. 3. Heart Surgery Unit, Mauriziano Hospital, 62, Largo Filippo Turati, 10128, Turin, Italy. 4. Heart Surgery Unit, European Hospital, 700, Via portuense, 00149, Rome, Italy.
Abstract
BACKGROUND: previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting. METHODS: 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events. RESULTS: 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack. CONCLUSIONS: External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates. TRIAL REGISTRATION: Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).
BACKGROUND: previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting. METHODS: 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events. RESULTS: 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack. CONCLUSIONS: External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates. TRIAL REGISTRATION: Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).
Authors: Carolyn M Webb; Eyal Orion; David P Taggart; Keith M Channon; Carlo Di Mario Journal: Eur Heart J Cardiovasc Imaging Date: 2015-11-30 Impact factor: 6.875
Authors: Jamie Y Jeremy; Pat Gadsdon; Nilima Shukla; Vikram Vijayan; Marcella Wyatt; Andrew C Newby; Gianni D Angelini Journal: Biomaterials Date: 2006-11-17 Impact factor: 12.479
Authors: Ralf E Harskamp; Renato D Lopes; Clinton E Baisden; Robbert J de Winter; John H Alexander Journal: Ann Surg Date: 2013-05 Impact factor: 12.969
Authors: David P Taggart; Yanai Ben Gal; Belinda Lees; Niket Patel; Carolyn Webb; Syed M Rehman; Anthony Desouza; Rashmi Yadav; Fabio De Robertis; Miles Dalby; Adrian Banning; Keith M Channon; Carlo Di Mario; Eyal Orion Journal: Ann Thorac Surg Date: 2015-04-15 Impact factor: 4.330
Authors: Tomer Meirson; Eyal Orion; Carlo Di Mario; Carolyn Webb; Niket Patel; Keith M Channon; Yanai Ben Gal; David P Taggart Journal: J Thorac Cardiovasc Surg Date: 2015-07-02 Impact factor: 5.209
Authors: Thomas A Schwann; James Tatoulis; John Puskas; Mark Bonnell; David Taggart; Paul Kurlansky; Jeffery P Jacobs; Vinod H Thourani; Sean O'Brien; Amelia Wallace; Milo C Engoren; Robert F Tranbaugh; Robert H Habib Journal: Semin Thorac Cardiovasc Surg Date: 2017-08-08
Authors: Mario Gaudino; Umberto Benedetto; Stephen Fremes; Giuseppe Biondi-Zoccai; Art Sedrakyan; John D Puskas; Gianni D Angelini; Brian Buxton; Giacomo Frati; David L Hare; Philip Hayward; Giuseppe Nasso; Neil Moat; Miodrag Peric; Kyung J Yoo; Giuseppe Speziale; Leonard N Girardi; David P Taggart Journal: N Engl J Med Date: 2018-04-30 Impact factor: 91.245