Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass. JAMA Surgery. June 2014. Ralf E. Harskamp, MD1,2; John H. Alexander, MD, MHS1; Phillip J. Schulte, PhD1; Colleen M. Brophy, MD3; Michael J. Mack, MD4; Eric D. Peterson, MD, MPH1; Judson B. Williams, MD, MHS1; C. Michael Gibson, MD, MS5; Robert M. Califf, MD6; Nicholas T. Kouchoukos, MD7; Robert A. Harrington, MD8; T. Bruce Ferguson Jr, MD9; Renato D. Lopes, MD, PhD1
1Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
2Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
3Division of Vascular Surgery, Vanderbilt University, Nashville, Tennessee
4Cardiopulmonary Research Science and Technology Institute, Dallas, Texas
5PERF– USE Angiographic Laboratory, Boston, Massachusetts
6Department of Medicine, Duke Translational Medicine Institute, Duke University, Durham, North Carolina
7Heart Center, Missouri Baptist Medical Center, St Louis, Missouri
8Department of Medicine, Stanford University, Stanford, California
9Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
Objective To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery.
Design, Setting, and Participants Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.
Interventions Preservation of vein grafts in saline, blood, or buffered saline solutions.
Main Outcomes and Measures One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization.
Results Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions.
Conclusions and Relevance Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions.