title: Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial.
abstract: OBJECTIVE
  In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking.
  
  
  OBJECTIVE
  To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery.
  
  
  METHODS
  Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.
  
  
  METHODS
  Preservation of vein grafts in saline, blood, or buffered saline solutions.
  
  
  METHODS
  One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization.
  
  
  RESULTS
  Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions.
  
  
  CONCLUSIONS
  Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00042081.
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina2Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Ralf E
authors: RE
authors: Harskamp
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors: John H
authors: JH
authors: Alexander
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors: Phillip J
authors: PJ
authors: Schulte
authors: Division of Vascular Surgery, Vanderbilt University, Nashville, Tennessee.
authors: Colleen M
authors: CM
authors: Brophy
authors: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors: Michael J
authors: MJ
authors: Mack
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors: Eric D
authors: ED
authors: Peterson
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors: Judson B
authors: JB
authors: Williams
authors: PERFUSE Angiographic Laboratory, Boston, Massachusetts.
authors: C Michael
authors: CM
authors: Gibson
authors: Department of Medicine, Duke Translational Medicine Institute, Duke University, Durham, North Carolina.
authors: Robert M
authors: RM
authors: Califf
authors: Heart Center, Missouri Baptist Medical Center, St Louis, Missouri.
authors: Nicholas T
authors: NT
authors: Kouchoukos
authors: Department of Medicine, Stanford University, Stanford, California.
authors: Robert A
authors: RA
authors: Harrington
authors: Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina.
authors: T Bruce
authors: TB
authors: Ferguson
authors: Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors: Renato D
authors: RD
authors: Lopes
mesh_terms: D000368:Aged; D002021:Buffers; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009841:Oligonucleotides; D019188:Organ Preservation Solutions; D012965:Sodium Chloride; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects; D014680:Veins
chemical_list: D002021:Buffers; D009841:Oligonucleotides; D019188:Organ Preservation Solutions; D012965:Sodium Chloride; C502518:edifoligide