The Disconnect Between Vein Graft Failure and Clinical Events Following CABG Surgery
The high attrition rate of vein grafts following CABG surgery is well documented. However, the expected clinical events associated with this attrition lags behind those observed in clinical practice. Vein graft patency is complex and multi-factorial and can be dependent on technical or patient variables. It's not unusual that these factors may be interrelated. Recurrent angina, or an acute event, and the need for revascularization remain the most common clinical manifestation of vein graft failure (VGF). In the vast majority of patients a percutaneous procedure is the norm rather than a repeat CABG. Another important factor in this equation is a patent left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD). The low failure rates of this graft 10 to 20 years after CABG, along with percutaneous interventions may have contributed to the major decline to the rate of reoperation CABG surgery.
Novel therapies that may theoretically reduce the incidence of VGF are both attractive and challenging. The question remains: is it necessary and worth the effort?
- Received September 23, 2014.
- Accepted September 24, 2014.