Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial.
Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial.
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DOI：
10.1001/jamasurg.2014.87
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发表时间：
2014-08
期刊：
影响因子：
16.9
通讯作者：
Lopes, Renato D.
中科院分区：
文献类型：
--
作者：
Harskamp, Ralf E.;Alexander, John H.;Schulte, Phillip J.;Brophy, Colleen M.;Mack, Michael J.;Peterson, Eric D.;Williams, Judson B.;Gibson, C. Michael;Califf, Robert M.;Kouchoukos, Nicholas T.;Harrington, Robert A.;Ferguson, T. Bruce, Jr.;Lopes, Renato D.
体外和动物模型数据表明，术中保存溶液可能会影响冠状动脉旁路移植术（CABG）手术后的内皮功能和静脉移植物衰竭（VGF）。缺乏临床研究来验证这些发现。评价静脉移植物保存溶液对接受CABG手术的患者的VGF和临床结局的影响。使用了来自体外静脉移植物工程通过转染IV（PREVENT IV）研究项目的数据，这是一项III期、多中心、随机、双盲、安慰剂对照试验，从2002年8月1日至2003年10月22日在107个美国研究中心招募了3014例患者。试验的合格标准包括冠状动脉疾病的CABG手术，至少有2个计划的静脉移植。在生理盐水、血液或缓冲生理盐水溶液中保存静脉移植物。1年血管造影VGF和5年死亡率、心肌梗死率及随后的血运重建率。大多数患者将移植物保存在盐水中（1339 [44.4%]），其次是血液（971 [32.2%]）和缓冲盐水（507 [16.8%]）。各组的基线特征相似。缓冲盐水组的1年VGF率远低于盐水组（患者水平比值比[OR]，0.59 [95% CI，0.45 - 0.78; P <0.001];移植物水平OR，0.63 [95% CI，0.49 - 0.79; P <0.001]）或血型（患者水平OR，0.62 [95% CI，0.46 - 0.83; P = 0.001];移植物水平OR，0.63 [95% CI，0.48 - 0.81; P <0.001]）。与生理盐水（风险比，0.81 [95% CI，0.64 - 1.02; P = 0.08]）和血液（0.81 [0.63 - 1.03; P = 0.09]）溶液相比，使用缓冲生理盐水溶液的5年死亡、心肌梗死或后续血运重建风险往往较低。与移植物保存在生理盐水或血液溶液中的患者相比，接受CABG的静脉移植物保存在缓冲盐水溶液中的患者VGF率较低，长期临床结局趋势更好。
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.
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影响因子：
4.6
作者：
Thatte, HS;Biswas, KS;Khuri, SF
通讯作者：
Khuri, SF
影响因子：
37.8
作者：
Lopes RD;Mehta RH;Hafley GE;Williams JB;Mack MJ;Peterson ED;Allen KB;Harrington RA;Gibson CM;Califf RM;Kouchoukos NT;Ferguson TB Jr;Alexander JH;Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators
通讯作者：
Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators
影响因子：
4.6
作者：
Hinokiyama, Kazuhiro;Valen, Guro;Vaage, Jarle
通讯作者：
Vaage, Jarle
影响因子：
3.4
作者：
SANTOLI, E;DIMATTIA, D;SANTOLI, C
通讯作者：
SANTOLI, C
影响因子：
4.8
作者：
Lopes, Renato D.;Williams, Judson B.;Alexander, John H.
通讯作者：
Alexander, John H.