Highly flexible nitinol mesh to encase aortocoronary saphenous vein grafts: First clinical experiences and angiographic results nine months postoperatively
Saphenous vein graft patency is frequently limited by degeneration. Experimental studies have indicated that rigid external support of venous grafts by a flexible, tubular nitinol mesh may improve graft patency. The study presented was part of a prospective, randomized, multicenter first-in-man trial investigating the safety and effectiveness of nitinol-supported venous grafts in coronary artery bypass graft (CABG) surgery. From our clinic, 25 subjects with multivessel coronary artery disease requiring saphenous vein graft CABG of the right coronary artery (RCA) and the circumflex artery were entered into the trial. Subjects were randomized to receive a mesh-supported graft on one of these arteries; the other vessel received an untreated vein graft. Graft patency was assessed by coronary angiography nine months after surgery. The implantation of mesh grafts was simple and safe. In 10 cases, a nitinol mesh-supported venous graft was anastomosed to the circumflex artery and in 15 cases to the RCA. All patients survived the observation period. A total of 72% of the patients underwent control coronary angiography. The patency rate of mesh-supported grafts was 27.8% nine months postoperatively. Conventional vein grafts showed an 85.7% patency, and arterial grafts had a 100% patency. No complications directly related to the implantation of mesh-supported grafts were observed. The promising experimental results of mesh-supported venous grafts could not be reproduced in the study presented. A critical item seems to be correct selection of nitinol mesh diameter, the anastomotic method and fixation of the mesh tube to the venous graft.
Available from: Devdas Thomas Inderbitzin
- "In conclusion, we consider the clinical results published by Schoettler et al.  to be worrisome. Previously identified risk factors, such as too aggressive downsizing, meshing vein grafts with a diameter <3 mm and double wall thickness >1.4 mm and omitting redundant side-branch tissue resection as well as pedicular distal graft incision should be avoided for future application . "
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ABSTRACT: The eSVS Mesh (Kipps Bay Medical, Minneapolis, MN USA) Mesh (Kipps Bay Medical, Minneapolis, MN USA) is a new concept in improving saphenous vein graft patency for coronary bypass grafting. This is a nitinol-based external support device that maintains external support of the graft and prevents detrimental expansion when exposed to arterial pressure. The implanting technique is critical to outcomes and is described in this article. Clinical testing in the United States is pending. Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery.
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ABSTRACT: Coronary artery bypass surgery is a highly effective and durable therapy of coronary artery disease. Together with internal mammary arteries the saphenous vein grafts are the most important conduits for coronary surgery. We reviewed the topic of local pharmacologic and gene therapeutic treatment approaches to prevent neointimal hyperplasia in vein grafts. Perivascular therapy of veins before arterialization would be a simple approach that avoids systemic side effects of medications. The current data available show that there are promising experimental approaches (in vitro models, animal in vivo models) for pharmacological and gene therapeutic treatment of vein graft failure.
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