The Experts below are selected from a list of 8664 Experts worldwide ranked by ideXlab platform
Ralf E Harskamp - One of the best experts on this subject based on the ideXlab platform.
-
vein Graft Preservation solutions patency and outcomes after coronary artery bypass Graft surgery follow up from the prevent iv randomized clinical trial
JAMA Surgery, 2014Co-Authors: Ralf E Harskamp, John H Alexander, Phillip J Schulte, Colleen M Brophy, Michael J Mack, Eric D Peterson, Judson B Williams, Michael C Gibson, Robert M CaliffAbstract:Importance In vitro and animal model data suggest that intraoperative Preservation solutions may influence endothelial function and vein Graft failure (VGF) after coronary artery bypass Graft (CABG) surgery. Clinical studies to validate these findings are lacking. 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 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. Trial Registration clinicaltrials.gov Identifier:NCT00042081
-
vein Graft Preservation solutions patency and outcomes after coronary artery bypass Graft surgery follow up from the prevent iv randomized clinical trial
JAMA Surgery, 2014Co-Authors: Ralf E Harskamp, John H Alexander, Phillip J Schulte, Colleen M Brophy, Michael J Mack, Eric D Peterson, Judson B Williams, Michael C Gibson, Robert M CaliffAbstract:In vitro and animal model data suggest that intraoperative Preservation solutions may influence endothelial function and vein Graft failure (VGF) after coronary artery bypass Graft (CABG) surgery. Clinical studies to validate these findings are lacking. To evaluate the effect of vein Graft Preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. 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. Preservation of vein Grafts in saline, blood, or buffered saline solutions. One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. 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. 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. clinicaltrials.gov Identifier: NCT00042081
Dominic A. Delaurentis - One of the best experts on this subject based on the ideXlab platform.
-
Differences in early versus late extracavitary arterial Graft infections
Journal of vascular surgery, 1995Co-Authors: Keith D. Calligaro, Frank J Veith, Matthew J Dougherty, Michael L. Schwartz, Dominic A. DelaurentisAbstract:Abstract Purpose: The purpose of this report was to determine differences in presentation, bacteriology, management, and outcome of early (EGIs) versus late extracavitary arterial Graft infections (LGIs). Methods: Between July 1, 1979, and June 30, 1994, we treated 141 patients with infected extracavitary arterial Grafts (112 prosthetic, 29 vein) with selective partial or complete Graft Preservation. Results: A total of 99 (70%) EGIs ( ( p > 0.05). Patients with EGIs were as likely to have a disrupted anastomosis (17% [17 of 99] vs 21% [9 of 42]) or systemic sepsis (4% [4 of 99] vs 4% [2 of 42]) as patients with LGIs, respectively ( p > 0.05). Patients with EGIs were more likely to have patent, intact Grafts and to be treated by complete Graft Preservation (61% [61 of 99] vs 26% [11 of 42]) ( p = 0.0001). In comparison, patients with LGIs were more likely to have occluded Grafts and to require subtotal Graft excision (48% [20 of 42] vs 18% [18 of 99]) ( p = 0.0001). Surviving patients with EGIs treated by complete Graft Preservation were more likely to have successful healing of their wounds after long-term follow-up (average 3 years) than patients with LGIs (79% [41 of 52] vs 40% [4 of 10], respectively) ( p = 0.03). The pathogens cultured from wounds of EGIs versus LGIs were pure gram-positive bacteria in 49 (49%) versus 19 (46%), pure gram-negatives in 18 (18%) versus 11 (26%), and both types in 33 (33%) versus 12 (28%) ( p > 0.05). Conclusion : Complete Graft Preservation can be attempted more frequently and is more likely to be successful in EGIs than in LGIs. No difference in bacteriology was seen between the two groups. Graft-preserving treatment can be successful but should only be cautiously attempted in patients with late extracavitary arterial Graft infections. (J VASC SURG 1995;22:680-8.)
-
Selective Preservation of infected prosthetic arterial Grafts. Analysis of a 20-year experience with 120 extracavitary-infected Grafts.
Annals of surgery, 1994Co-Authors: Keith D. Calligaro, Ronald P. Savarese, Frank J Veith, Matthew J Dougherty, Michael L. Schwartz, Jamie Goldsmith, Dominic A. DelaurentisAbstract:OBJECTIVE: The authors report on their 20-year experience with 120 patients with infected extracavitary prosthetic arterial Grafts (95 polytetraflouroethylene, 25 Dacron). Throughout this experience, an effort was made, when appropriate, to salvage all or a portion of these infected Grafts. METHODS: When patients had arterial bleeding (20 cases) or systemic sepsis (6 cases), immediate Graft excision was performed. When the infected Graft was occluded (43 cases), subtotal Graft excision was performed, leaving an oversewn 2- to 3-mm Graft remnant to maintain patency of the artery. Complete Graft Preservation was attempted in 51 cases in which the Graft was patent, the patient was not septic, and the anastomoses were intact. Aggressive operative wound debridement was repeated, as necessary, to achieve wound healing. The preferred method of revascularization, when necessary, included secondary bypasses tunneled through uninfected (often lateral) routes. Follow-up averaged 3 years (range, 1 month-20 years). RESULTS: This strategy resulted in a hospital mortality of 12% (14/120) and a hospital amputation rate in survivors of 13% (14/106 threatened limbs). Of the surviving patients treated by complete Graft Preservation, the hospital amputation rate was only 4% (2/45) and long-term complete Graft Preservation was successful in 71% (32/45) of cases. Partial Graft Preservation also proved successful in 85% (35/41) of surviving patients who had occluded Grafts. Successful complete Graft Preservation was as likely when gram-negative or gram-positive bacteria were cultured from the wound, with the exception of Pseudomonas (successful Graft Preservation in only 40% [4/10] of cases). CONCLUSION: Based on this 20-year experience, the authors conclude that selective partial or complete Graft Preservation represents a simpler and better method of managing infected extracavitary prosthetic Grafts than routine total Graft excision.
-
Infrainguinal anastomotic arterial Graft infections treated by selective Graft Preservation.
Annals of surgery, 1992Co-Authors: Keith D. Calligaro, C. J. Westcott, R M Buckley, Ronald P. Savarese, Dominic A. DelaurentisAbstract:The purpose of this study was to determine whether the type of Graft material and bacteria involved in an infrainguinal arterial anastomotic infection can be used as guidelines for Graft Preservation. Between 1972 and 1990, the authors treated 35 anastomotic infections involving a common femoral or distal artery. The Graft material was Dacron in 14 patients, polytetrafluoroethylene (PTFE) in 14, and vein in 7. Of the 14 Dacron Grafts, immediate Graft excision was required for overwhelming infection in eight patients (bleeding in five, sepsis in three) and for an occluded Graft in one patient. Three of five patients failed attempted Graft Preservation because of nonhealing wounds. Thus, 12 of the 14 Dacron Grafts ultimately required Graft excision. Of the 21 "smooth-walled" vein and PTFE Grafts, 10 required immediate Graft excision for occluded Grafts (five PTFE, one vein) or bleeding (three PTFE, one vein). Ten of the remaining 11 (91%) patients with patent "smooth-walled" Grafts, intact anastomoses, and absence of sepsis managed by Graft Preservation healed their wounds and maintained distal arterial perfusion. Wound cultures grew pure gram-positive cocci in 17 of 21 "smooth-walled" Graft infections versus 8 of 14 Dacron Graft infections. In the absence of systemic sepsis, Graft Preservation is the treatment of choice for gram-positive infections involving an intact anastomosis of patent PTFE and vein Grafts. Regardless of the bacterial cause, the authors recommend that any infrainguinal anastomotic infection of a Dacron Graft be treated by immediate excision of all infected Graft material.
-
Management of infected lower extremity autologous vein Grafts by selective Graft Preservation.
American journal of surgery, 1992Co-Authors: Keith D. Calligaro, Ronald P. Savarese, Frank J Veith, Michael L. Schwartz, Jamie Goldsmith, Carl J. Westcott, Dominic A. DelaurentisAbstract:Between 1975 and 1991, we treated 16 patientswith infected lower extremity autologous vein Grafts performed for limb salvage by complete Graft Preservation. Traditional treatment of these infections includes immediate Graft excision and complex revascularization procedures to prevent limb loss. The infection involved an intact anastomosis in 12 patients or the body of a patent Graft in 4 patients. None of the patients was systemically septic. All patients were treated with appropriate intravenous antibioties. Six patients were treated by placement of autologous tissue on the exposed Graft (4 rotational muscle flaps, 2 skin Grafts), and 10 were treated with antibiotic-soaked dressing changes and repeated operative debridements to achieve delayed secondary wound healing. This treatment resulted in a 19% (3 of 16) mortality rate and an 8% (1 of 13) amputation rate in survivors. Of the six patients managed by autologous tissue placement onto the infected Graft, five patients had wounds that healed without complications, and one died of a myocardial infarction. Of the 10 patients treated by delayed secondary wound healing, 2 developed anastomotic hemorhage, which resulted in death in 1 patient and above-knee amputation in the other, 1 died of a myocardial infarction, 1 developed Graft thrombosis, and 6 had wounds that healed. Placement of autologous tissue to cover an exposed, infected patent vein Graft with intact anastomoses may prevent Graft dessication, disruption, and thrombosis, which renders Graft Preservation an easier, safer method of treatment compared with routine Graft excision.
Keith D. Calligaro - One of the best experts on this subject based on the ideXlab platform.
-
intra abdominal aortic Graft infection complete or partial Graft Preservation in patients at very high risk
Journal of Vascular Surgery, 2003Co-Authors: Keith D. Calligaro, Frank J Veith, John G Yuan, Nicholas J Gargiulo, Matthew J DoughertyAbstract:Abstract Background Total Graft excision with in situ or extra-anatomic revascularization is considered mandatory to treat infection involving the body of aortic Grafts. We present a series of nine patients with this complication and such severe comorbid medical illnesses or markedly hostile abdomens that traditional treatments were precluded. In these patients selective complete or partial Graft Preservation was used. Methods Over the past 20 years we have treated nine infected infrarenal aortic prosthetic Grafts with complete or partial Graft Preservation, because excision of the Graft body was not feasible. In all nine patients infection of the main body of the aortic Graft was documented at computed tomography or surgery. Essential adjuncts included percutaneous or operative drain placement into retroperitoneal abscess cavities and along the Graft, with instillation of antibiotics three times daily, repeated debridement of infected groin wounds, and intravenous antibiotic therapy for at least 6 weeks. Results One patient with purulent groin drainage treated with complete Graft Preservation died of sepsis. One patient with groin infection treated with complete Graft Preservation initially did well, but ultimately required total Graft excision 5 months later, after clinical improvement. In four patients complete Graft Preservation was successful; two patients required excision of an occluded infected limb of the Graft; and one patient underwent subtotal Graft excision, leaving a Graft remnant on the aorta, and axillopopliteal bypass. In summary, seven of nine patients survived hospitalization after complete or partial Graft Preservation; amputation was avoided in all but one patient; and no recurrent infection developed over mean follow-up of 7.6 years (range, 2-15 years). Conclusions Although contrary to conventional concepts, partial or complete Graft Preservation combined with aggressive drainage and groin wound debridement is an acceptable option for treatment of infection involving an entire aortic Graft in selected patients with prohibitive risks for total Graft excision. This treatment may be compatible with long-term survival and protracted absence of signs or symptoms of infection.
-
Differences in early versus late extracavitary arterial Graft infections
Journal of vascular surgery, 1995Co-Authors: Keith D. Calligaro, Frank J Veith, Matthew J Dougherty, Michael L. Schwartz, Dominic A. DelaurentisAbstract:Abstract Purpose: The purpose of this report was to determine differences in presentation, bacteriology, management, and outcome of early (EGIs) versus late extracavitary arterial Graft infections (LGIs). Methods: Between July 1, 1979, and June 30, 1994, we treated 141 patients with infected extracavitary arterial Grafts (112 prosthetic, 29 vein) with selective partial or complete Graft Preservation. Results: A total of 99 (70%) EGIs ( ( p > 0.05). Patients with EGIs were as likely to have a disrupted anastomosis (17% [17 of 99] vs 21% [9 of 42]) or systemic sepsis (4% [4 of 99] vs 4% [2 of 42]) as patients with LGIs, respectively ( p > 0.05). Patients with EGIs were more likely to have patent, intact Grafts and to be treated by complete Graft Preservation (61% [61 of 99] vs 26% [11 of 42]) ( p = 0.0001). In comparison, patients with LGIs were more likely to have occluded Grafts and to require subtotal Graft excision (48% [20 of 42] vs 18% [18 of 99]) ( p = 0.0001). Surviving patients with EGIs treated by complete Graft Preservation were more likely to have successful healing of their wounds after long-term follow-up (average 3 years) than patients with LGIs (79% [41 of 52] vs 40% [4 of 10], respectively) ( p = 0.03). The pathogens cultured from wounds of EGIs versus LGIs were pure gram-positive bacteria in 49 (49%) versus 19 (46%), pure gram-negatives in 18 (18%) versus 11 (26%), and both types in 33 (33%) versus 12 (28%) ( p > 0.05). Conclusion : Complete Graft Preservation can be attempted more frequently and is more likely to be successful in EGIs than in LGIs. No difference in bacteriology was seen between the two groups. Graft-preserving treatment can be successful but should only be cautiously attempted in patients with late extracavitary arterial Graft infections. (J VASC SURG 1995;22:680-8.)
-
Selective Preservation of infected prosthetic arterial Grafts. Analysis of a 20-year experience with 120 extracavitary-infected Grafts.
Annals of surgery, 1994Co-Authors: Keith D. Calligaro, Ronald P. Savarese, Frank J Veith, Matthew J Dougherty, Michael L. Schwartz, Jamie Goldsmith, Dominic A. DelaurentisAbstract:OBJECTIVE: The authors report on their 20-year experience with 120 patients with infected extracavitary prosthetic arterial Grafts (95 polytetraflouroethylene, 25 Dacron). Throughout this experience, an effort was made, when appropriate, to salvage all or a portion of these infected Grafts. METHODS: When patients had arterial bleeding (20 cases) or systemic sepsis (6 cases), immediate Graft excision was performed. When the infected Graft was occluded (43 cases), subtotal Graft excision was performed, leaving an oversewn 2- to 3-mm Graft remnant to maintain patency of the artery. Complete Graft Preservation was attempted in 51 cases in which the Graft was patent, the patient was not septic, and the anastomoses were intact. Aggressive operative wound debridement was repeated, as necessary, to achieve wound healing. The preferred method of revascularization, when necessary, included secondary bypasses tunneled through uninfected (often lateral) routes. Follow-up averaged 3 years (range, 1 month-20 years). RESULTS: This strategy resulted in a hospital mortality of 12% (14/120) and a hospital amputation rate in survivors of 13% (14/106 threatened limbs). Of the surviving patients treated by complete Graft Preservation, the hospital amputation rate was only 4% (2/45) and long-term complete Graft Preservation was successful in 71% (32/45) of cases. Partial Graft Preservation also proved successful in 85% (35/41) of surviving patients who had occluded Grafts. Successful complete Graft Preservation was as likely when gram-negative or gram-positive bacteria were cultured from the wound, with the exception of Pseudomonas (successful Graft Preservation in only 40% [4/10] of cases). CONCLUSION: Based on this 20-year experience, the authors conclude that selective partial or complete Graft Preservation represents a simpler and better method of managing infected extracavitary prosthetic Grafts than routine total Graft excision.
-
Infrainguinal anastomotic arterial Graft infections treated by selective Graft Preservation.
Annals of surgery, 1992Co-Authors: Keith D. Calligaro, C. J. Westcott, R M Buckley, Ronald P. Savarese, Dominic A. DelaurentisAbstract:The purpose of this study was to determine whether the type of Graft material and bacteria involved in an infrainguinal arterial anastomotic infection can be used as guidelines for Graft Preservation. Between 1972 and 1990, the authors treated 35 anastomotic infections involving a common femoral or distal artery. The Graft material was Dacron in 14 patients, polytetrafluoroethylene (PTFE) in 14, and vein in 7. Of the 14 Dacron Grafts, immediate Graft excision was required for overwhelming infection in eight patients (bleeding in five, sepsis in three) and for an occluded Graft in one patient. Three of five patients failed attempted Graft Preservation because of nonhealing wounds. Thus, 12 of the 14 Dacron Grafts ultimately required Graft excision. Of the 21 "smooth-walled" vein and PTFE Grafts, 10 required immediate Graft excision for occluded Grafts (five PTFE, one vein) or bleeding (three PTFE, one vein). Ten of the remaining 11 (91%) patients with patent "smooth-walled" Grafts, intact anastomoses, and absence of sepsis managed by Graft Preservation healed their wounds and maintained distal arterial perfusion. Wound cultures grew pure gram-positive cocci in 17 of 21 "smooth-walled" Graft infections versus 8 of 14 Dacron Graft infections. In the absence of systemic sepsis, Graft Preservation is the treatment of choice for gram-positive infections involving an intact anastomosis of patent PTFE and vein Grafts. Regardless of the bacterial cause, the authors recommend that any infrainguinal anastomotic infection of a Dacron Graft be treated by immediate excision of all infected Graft material.
-
Management of infected lower extremity autologous vein Grafts by selective Graft Preservation.
American journal of surgery, 1992Co-Authors: Keith D. Calligaro, Ronald P. Savarese, Frank J Veith, Michael L. Schwartz, Jamie Goldsmith, Carl J. Westcott, Dominic A. DelaurentisAbstract:Between 1975 and 1991, we treated 16 patientswith infected lower extremity autologous vein Grafts performed for limb salvage by complete Graft Preservation. Traditional treatment of these infections includes immediate Graft excision and complex revascularization procedures to prevent limb loss. The infection involved an intact anastomosis in 12 patients or the body of a patent Graft in 4 patients. None of the patients was systemically septic. All patients were treated with appropriate intravenous antibioties. Six patients were treated by placement of autologous tissue on the exposed Graft (4 rotational muscle flaps, 2 skin Grafts), and 10 were treated with antibiotic-soaked dressing changes and repeated operative debridements to achieve delayed secondary wound healing. This treatment resulted in a 19% (3 of 16) mortality rate and an 8% (1 of 13) amputation rate in survivors. Of the six patients managed by autologous tissue placement onto the infected Graft, five patients had wounds that healed without complications, and one died of a myocardial infarction. Of the 10 patients treated by delayed secondary wound healing, 2 developed anastomotic hemorhage, which resulted in death in 1 patient and above-knee amputation in the other, 1 died of a myocardial infarction, 1 developed Graft thrombosis, and 6 had wounds that healed. Placement of autologous tissue to cover an exposed, infected patent vein Graft with intact anastomoses may prevent Graft dessication, disruption, and thrombosis, which renders Graft Preservation an easier, safer method of treatment compared with routine Graft excision.
Robert M Califf - One of the best experts on this subject based on the ideXlab platform.
-
vein Graft Preservation solutions patency and outcomes after coronary artery bypass Graft surgery follow up from the prevent iv randomized clinical trial
JAMA Surgery, 2014Co-Authors: Ralf E Harskamp, John H Alexander, Phillip J Schulte, Colleen M Brophy, Michael J Mack, Eric D Peterson, Judson B Williams, Michael C Gibson, Robert M CaliffAbstract:Importance In vitro and animal model data suggest that intraoperative Preservation solutions may influence endothelial function and vein Graft failure (VGF) after coronary artery bypass Graft (CABG) surgery. Clinical studies to validate these findings are lacking. 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 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. Trial Registration clinicaltrials.gov Identifier:NCT00042081
-
vein Graft Preservation solutions patency and outcomes after coronary artery bypass Graft surgery follow up from the prevent iv randomized clinical trial
JAMA Surgery, 2014Co-Authors: Ralf E Harskamp, John H Alexander, Phillip J Schulte, Colleen M Brophy, Michael J Mack, Eric D Peterson, Judson B Williams, Michael C Gibson, Robert M CaliffAbstract:In vitro and animal model data suggest that intraoperative Preservation solutions may influence endothelial function and vein Graft failure (VGF) after coronary artery bypass Graft (CABG) surgery. Clinical studies to validate these findings are lacking. To evaluate the effect of vein Graft Preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. 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. Preservation of vein Grafts in saline, blood, or buffered saline solutions. One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. 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. 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. clinicaltrials.gov Identifier: NCT00042081
David P Taggart - One of the best experts on this subject based on the ideXlab platform.
-
intraoperative vein Graft Preservation what is the solution
The Annals of Thoracic Surgery, 2016Co-Authors: Lavinia C Woodward, Charalambos Antoniades, David P TaggartAbstract:Saphenous vein Graft (SVG) disease and subsequent vein Graft failure remain a major problem after coronary artery bypass Graft operations. In an effort to mitigate loss of endothelial viability, the vein is stored, intraoperatively, in a Preservation solution. However, human SVG samples demonstrate endothelial denudation and dysfunction after such storage, the severity of which varies, depending on the medium. The paucity of clinical data evaluating Preservation solutions is illustrated by the absence of optimal procedural protocol. This review evaluates the potential efficacy of different storage solutions in preserving vein Grafts, in relation to a mechanistic understanding of SVG pathophysiology.
