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Eur J Cardiothorac Surg. 2017 May 1;51(5):952-958. doi: 10.1093/ejcts/ezw438.

A prospective study of external stenting of saphenous vein grafts to the right coronary artery: the VEST II study.

Author information

1
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
2
Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
3
Department of Cardiovascular Medicine, Oxford University Hospitals Trust, Oxford, UK.
4
Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, UK.

Abstract

OBJECTIVES:

External stents significantly reduce intimal hyperplasia and improve lumen uniformity and flow pattern in saphenous vein grafts (SVG) 1 year after coronary artery bypass grafting. However, recent studies have shown that at 1 year there is a lower patency of externally stented SVG to the right coronary artery (RCA) (55-60%) when compared to the left sided coronary arteries (85-90%). In the current study, we investigated whether avoidance of both fixation of the external stent to the anastomoses and the use of metal clips to ligate SVG side branches would improve the early patency of externally stented SVG to the RCA.

METHODS:

Thirty patients received a SVG to the right territory supported with an external stent. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG patency assessed by computed tomography angiography (CTA) at 3-6 months. Graft failure was defined as > 50% stenosis.

RESULTS:

Twenty-nine patients (96.6%) completed the follow up period and CT angiography data was available for a total of 43 SVGs, (29 supported and 14 unsupported SVGs) and 47 arterial grafts. Patency of stented SVGs was 86.2% (25/29 on CTA). All non-stented SVGs to the left territory were patent. Patency rates of the left internal mammary arteries and right internal mammary arteries grafts were 96.6% and 83.3%, respectively.

CONCLUSIONS:

Avoidance of both metallic clips to ligate side branches and of fixation of venous external support trial (VEST) stents to the anastomoses mark a significant improvement in patency of stented SVG to the right coronary territory.

KEYWORDS:

CT angiography; Coronary artery bypass surgery; External stenting; Graft patency

PMID:
28379404
DOI:
10.1093/ejcts/ezw438
[Indexed for MEDLINE]

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