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.
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.