VEST External Support Enhanced CABG:Mid Term Clinical Follow Up of a Multicentric Study

BACKGROUND

In contemporary CABG, SVG is the most utilized second conduit. In the short term, up to 1 year post implantation, SVG performance is influenced primarily by harvesting technique, preservation method, and the coronary target quality.

In the long term, the development of intimal hyperplasia and accelerated atherosclerosis limit the longevity of SVG. 10 years post CABG, the majority of SVG are either occluded or severely diseased.

VEST is an external support device implanted over the saphenous vein graft by cardiac surgeons during CBAG surgery, demonstrated in multiple randomized controlled studies consistent evidence about the biological mechanism of action in preventing SVG disease

The objective of this multicentric study is to evaluate the mid-term clinical outcome of VEST enhanced surgical revascularization when used in real world routine practice.

METHODS

A total of 397 patients underwent CABG in a three-center setting, with at least one SVG supported with an external stent. The majority (73.3%) of patients underwent on-pump CABG and the average number of grafts per patient was three. Patients were followed for major adverse cardiac and cerebral events (MACCE) for a median duration of 24 (1-101) months.

RESULTS

Overall, 469 of 654 SVG (71.7%) received external stents. Freedom from MACCE at 1, 3 and 5 years was 95.1% (SE 0.011), 85.4% (SE 0.021), and 82.4% (SE 0.030) respectively. Revascularization rates in territories which were grafted with stented SV was low in general (1.28%) and statistically significantly lower than in territories grafted with a non-stented SVG (4.32%, p=0.015). Arterially grafted territories confirmed low revascularization rates as well (0.9%)

CONCLUSION

VEST-enhanced CABG is feasible and associated with low MACCE in real world routine practice which includes on and off pump CABG and sequential grafting. Midterm clinical follow up suggests that VEST enhanced CABG is associated with very low site-specific revascularization rates.