Abstract 14160: Preservation Solutions, Patency, and Outcomes After Coronary Bypass Surgery
Background: Data from in vitro and animal models suggest that intraoperative vein graft preservation solutions may influence vein graft failure (VGF) following coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking.
Methods: Using data from the PREVENT-IV trial (n=3,014), one-year angiographic follow-up for VGF and 5-year clinical outcomes (composite of death, myocardial infarction (MI), and revascularization) were determined in patients in whom vein grafts were preserved in saline , blood, or buffered-saline solution. Logistic regression was used to compare rates of VGF, and generalized-estimating-equations methods were used to account for correlations among grafts. Kaplan-Meier estimates and Cox hazards regression were used to compare clinical outcomes.
Results: The largest number of patients had grafts preserved in a saline solution (n=1339, 44.4%), followed by blood solution (n=971, 32.2%), and buffered-saline solution (n= 507, 16.8%). Baseline and operative characteristics were similar among the groups. As shown in Figure 1, 1-year VGF rates were >20% lower in the buffered-saline solutions group, compared with the saline group (patient-level: odds ratio (OR):0.59 [0.45,0.78], p<0.001, graft-level: OR:0.63 [0.49, 0.79], p<0.001) and blood group (patient-level: OR:0.62 [0.46,0.83], p=0.001, graft-level: OR:0.63 [0.48, 0.81], p<0.001). Buffered-saline solutions also tended to be associated with lower risk of 5-year adverse clinical outcomes compared with saline solutions (hazard ratio (HR):0.81 [0.64,1.02], p=0.075) and blood solutions (HR:0.81 [0.63, 1.03], p=0.085).
Conclusion: Patients undergoing CABG surgery whose vein grafts were preserved intraoperatively in a buffered-saline solution had lower failure rates and a trend toward better long-term clinical outcomes compared with saline or blood based solutions.
- © 2013 by American Heart Association, Inc.