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a Cardiothoracic Surgery Department, Tufts University School of Medicine and Caritas St. Elizabeth’s Medical Center, Boston, Massachusetts
b The Fuqua Heart Center, Piedmont Hospital, Atlanta, Georgia
c Massachusetts Institute of Technology, Cambridge, Massachusetts
d Cardiovascular Divisions, Departments of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
e Cardiopulmonary Research, Science and Technology Institute, Dallas, Texas
f Duke Clinical Research Institute, Durham, North Carolina
g Missouri Baptist Medical Center, St. Louis, Missouri
h East Carolina Heart Institute, Brody School of Medicine at East Carolina University, Greenville, North Carolina
Accepted for publication October 17, 2007.
* Address correspondence to Dr Gibson, TIMI Data Coordinating Center, 350 Longwood Avenue, First Floor, Boston, MA 02115 (Email: mgibson{at}perfuse.org).
Background: Use of saphenous vein graft (SVG) radiographic markers has been associated with shorter cardiac catheterization procedure times and reduced contrast agent volume for postoperative coronary artery bypass graft (CABG) catheterizations. Use of such markers is varied and often operator-dependent, as the effect of SVG markers has not been fully evaluated. The goal of the present analysis was to evaluate the association of SVG markers with clinical outcomes and graft patency.
Methods: Data were drawn from the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial of patients undergoing CABG at 107 hospitals across the United States. Repeat angiography was performed within 12 to 18 months after CABG. The SVG markers were used at the discretion of the surgeon and were identified on the follow-up angiogram as any device used to mark the ostium, regardless of shape.
Results: The SVG markers were present in 51.2% of evaluable patients (910 of 1,778) and 52.3% of SVGs (2,228 of 4,240). Among patients with totally occluded SVGs (n = 911), visual identification of the SVG was obtained more frequently in those with an SVG marker (90.7% vs 72.1%, p < 0.001). The SVG stenosis 70% or greater at follow-up did not differ by use of markers (25.8% with marker vs 24.4% without marker, p = not significant). These findings were also consistent in ostial lesions (n = 942). Long-term death or myocardial infarction (MI) was similar by use of marker. The perioperative CABG MI was higher in patients with SVG markers (10.1% vs 5.5%, odds ratio adjusted 1.86, p = 0.021).
Conclusions: Saphenous vein graft radiographic markers were associated with higher rates of direct visualization of totally occluded SVGs without an adverse effect on graft patency or long-term clinical outcomes, but the association of SVG markers with increased perioperative CABG MI warrants further examination.
This article has been cited by other articles:
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  S. A. Olenchock Jr and C. M. Gibson Reply. Ann. Thorac. Surg., October 1, 2008; 86(4): 1402 - 1403. [Full Text] [PDF]
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M. Cikirikcioglu and E. Duran New discussion on an old subject: proximal anastomosis markers in coronary bypass surgery. Ann. Thorac. Surg., October 1, 2008; 86(4): 1401 - 1402. [Full Text] [PDF]
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