title: Virchow triad, but not use of an aortic connector device, predicts early graft failure after off-pump coronary bypass.
abstract: The risk of early thrombosis of coronary artery bypass (CAB) grafts may be increased after off-pump CAB, particularly after the use of an aortic connector device (ACD) to perform the proximal aortosaphenous anastomosis. We have been investigating tools that quantify the risk of early vein graft thrombosis after off-pump CAB on the basis of the Virchow triad of hypercoagulability, endothelial disease, and low conduit flow. These tools were applied in this prospective trial of a heterogeneous group of patients with varying degrees of aortic disease and who received the Symmetry ACD. After controlling for the Virchow risk factor triad, we hypothesized that the ACD does not independently influence graft thrombosis. There was no statistically significant difference in the early thrombosis rates of vein grafts connected with an ACD versus hand-sewn grafts (6.7% versus 6.5%). We found a wide range of graft flow measurements, platelet function, and vein endothelial phenotypes in patients with traditionally hand-sewn vein grafts and with grafts connected with an ACD in patients with a wide range of ascending aortic atherosclerosis. The perioperative combination of platelet hyperreactivity, marginal graft flow, and endothelial disease proved to be highly predictive of early graft failure as seen with postoperative computed tomographic angiography.
authors.affiliation: Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland 21201, USA. rposton@smail.umaryland.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Poston
authors.forename: Charles
authors.initials: C
authors.lastname: White
authors.forename: Katrina
authors.initials: K
authors.lastname: Read
authors.forename: Junyan
authors.initials: J
authors.lastname: Gu
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.forename: Thrity
authors.initials: T
authors.lastname: Avari
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
mesh_terms: D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000295:instrumentation; D019544:Equipment Failure Analysis / Q000379:methods*; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D011379:Prognosis; D011475:Prosthesis Failure; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology; D016896:Treatment Outcome