Though the no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, the effect of the off-pump technique on SVG patency remains ambiguous. Some of the solutions that may reduce the incidence of SVG failure:  

  • Use of buffered storage solutions,  

  • Careful selection of the target vessels,  

  • Intraoperative graft flow measurement,  

  • Physiological assessment of the native coronary circulation before CABG. 

The cornerstones of secondary prevention after CABG are high-intensity statin administration and perioperative aspirin. The recommended therapy for off-pump CABG and in ACS patients is Dual antiplatelet therapy. Stenoses of intermediate severity (30%-60%) often progress rapidly.  

Stenting of intermediate SVG stenoses did not improve outcomes; therefore, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality than percutaneous coronary intervention (PCI); consequently, most patients who need repeat revascularization after CABG prefer PCI. During the follow-up, it is observed that high rates of no-reflow and an increased incidence of restenosis limits the SVG PCI. Procedures like drug-eluting and bare-metal stents provide similar long-term outcomes in SVG PCI.  

Conclusion: 

The study’s authors conclude that PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible. 

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Keywords

Disease Condition,Therapeutic Modality,Coronary Artery Disease,Cardiovascular Surgery,Interventional Cardiology,Pharmacotherapeutics,DCAD_others,TCVS_others,TINC_others,TPHT_others

Source

https://pubmed.ncbi.nlm.nih.gov/34460327/

Tags

Disease Condition ,Therapeutic Modality ,Coronary Artery Disease,Cardiovascular Surgery,Interventional Cardiology,Pharmacotherapeutics,DCAD_others,TCVS_others,TINC_others,TPHT_others