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Comparison of alternate preparative techniques on wall thickness in coronary artery bypass grafts: the HArVeST randomised controlled trial
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  • Gianni Angelini,
  • Tom Johnson,
  • Culliford Lucy,
  • Gavin Murphy,
  • Tracy Harris,
  • Kate Ashton,
  • Julia Edwards,
  • Gemma Clayton,
  • Yong Cheol,
  • Andrew Newby,
  • Barney Reeves,
  • Chris Rogers
Gianni Angelini
Bristol University
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Tom Johnson
University of Bristol Faculty of Health Sciences
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Culliford Lucy
University of Bristol
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Gavin Murphy
University of Leicester
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Tracy Harris
University of Bristol
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Kate Ashton
University of Bristol
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Julia Edwards
University of Bristol
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Gemma Clayton
University of Bristol
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Yong Cheol
Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Andrew Newby
University of Bristol Faculty of Health Sciences
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Barney Reeves
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Chris Rogers
University of Bristol
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Abstract

Background: The success of coronary artery bypass grafting surgery (CABG) is dependent on long-term graft patency, which is negatively related to early wall thickening. Avoiding high-pressure distension testing for leaks and preserving the surrounding pedicle of fat and adventitia during vein harvesting may reduce wall thickening. Methods: A single-centre, factorial randomised controlled trial was carried out to compare the impact of testing for leaks under high versus low pressure and harvesting the vein with versus without the pedicle in patients undergoing CABG. The primary outcomes were graft wall thickness, as indicator of medial-intimal hyperplasia, and lumen diameter assessed using intravascular ultrasound after 12 months. Results: 96 eligible participants were recruited. With conventional harvest, low-pressure testing tended to yield a thinner vessel wall compared to high-pressure (mean difference MD (low minus high) -0.059mm, 95%CI -0.12, +0.0039, p=0.066). With high pressure testing, veins harvested with the pedicle fat tended to have a thinner vessel wall than those harvested conventionally (MD (pedicle minus conventional) -0.057mm, 95%CI -0.12, +0.0037, p=0.066, test for interaction p=0.07). Lumen diameter was similar across groups (harvest comparison p=0.81; pressure comparison p=0.24). Low pressure testing was associated with fewer hospital admissions in the 12 months following surgery (p=0.0008). Harvesting the vein with the pedicle fat was associated with more complications during the index admission (p=0.0041). Conclusions: Conventional saphenous vein graft preparation with low pressure distension and harvesting the vein with a surrounding pedicle yielded similar graft wall thickness after 12 months, but low pressure was associated with fewer adverse events.

Peer review status:ACCEPTED

13 Jan 2021Submitted to Journal of Cardiac Surgery
16 Jan 2021Submission Checks Completed
16 Jan 2021Assigned to Editor
16 Jan 2021Reviewer(s) Assigned
19 Jan 2021Review(s) Completed, Editorial Evaluation Pending
19 Jan 2021Editorial Decision: Revise Minor
20 Jan 20211st Revision Received
22 Jan 2021Submission Checks Completed
22 Jan 2021Assigned to Editor
22 Jan 2021Reviewer(s) Assigned
22 Jan 2021Review(s) Completed, Editorial Evaluation Pending
22 Jan 2021Editorial Decision: Accept