title: One-year patency control and risk analysis of eSVS®-mesh-supported coronary saphenous vein grafts.
abstract: BACKGROUND
  The eSVS® external venous nitinol mesh (Kips Bay Medical, Minneapolis, USA) was designed to improve long-term patency of coronary saphenous vein grafts (SVG) by preventing pressure-induced wall stress and reactive neo-intimal hyperplasia. We present one-year-patency rates of meshed SVGs assessed by coronary computed tomographic angiography (cCTA).
  
  
  METHODS
  Data from consecutive patients receiving an eSVS® meshed coronary bypass SVG from 06/2010 to 06/2011 were prospectively collected and analysed post-hoc. Patient characteristics, coronary artery disease, SVG quality, surgery (including number of anastomoses and transit time flow-measurement: TTFM), postoperative course and graft patency by cCTA were recorded. Potential risk factors for meshed graft occlusion were evaluated.
  
  
  RESULTS
  22 patients received an eSVS® mesh (18 isolated CABG, 4 combined with aortic valve replacement). Three patients died prior to the one-year follow-up and were excluded. All 19 surviving patients (mean age 70.4 ± 9.5 years, 3 female) completed a cCTA of all grafts at 12 ± 0.1 months after surgery including 21 meshed SVGs (33 distal anastomoses), 7 unmeshed SVGs (13 distal anastomoses) and 22 arterial grafts (30 distal anastomoses). Mesh application was safe with patent grafts (by intraoperative TTFM) and perioperative course uneventful in all patients. The average graft/anastomosis number per patient was 2.6 ± 0.5/3.7 ± 0.8. Patency was unrestricted in all arterial and unmeshed SVGs (cCTA). Meshed SVG patency was 85 % (n = 28/33) for distal anastomoses and 76 % (n = 16/21) among meshed SVGs. Four SVGs with single distal anastomosis to the right coronary were completely occluded. One sequential graft to the left coronary was occluded between proximal and first distal anastomosis (see Fig. 1). Patency was independent of target site, coronary run-off, SVG quality and sequential distal grafting. All patients were asymptomatic.
  
  
  CONCLUSIONS
  The overall one-year patency rate of eSVS® meshed SVGs/anastomoses was 76 %/85 %. Surgical implantation is safe independently of target site, run-off, vein quality and sequential distal anastomoses. However, graft patency of meshed veins (76 %) was inferior to non-meshed (100 %) or arterial grafts (100 %). Thus our mid-term data do not sustain the concept of improving vein graft patency by external reinforcing with the eSVS® mesh. Further long-term follow-up is warranted.
authors.affiliation: Department of Cardiac Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland. devdasinderbitzin@bluewin.ch.
authors.forename: Devdas T
authors.initials: DT
authors.lastname: Inderbitzin
authors.affiliation: Division of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Bremerich
authors.affiliation: Department of Cardiac Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Matt
authors.affiliation: Department of Cardiac Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
authors.forename: Martin T R
authors.initials: MT
authors.lastname: Grapow
authors.affiliation: Department of Cardiac Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
authors.forename: Friedrich S
authors.initials: FS
authors.lastname: Eckstein
authors.affiliation: Department of Cardiac Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reuthebuch
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013526:Surgical Mesh; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology*