An interventional study of graft configuration in coronary artery bypass grafting in Coronary Artery Disease and Morphologic Change, sponsored by Ho Young Hwang. Completed at 1 site in Korea, Republic of. Open to participants aged 19 Years and older. Per ClinicalTrials.gov, last updated 2024-04-19.
Sponsored by Ho Young Hwang · Not applicable, Interventional, and Treatment
Left internal thoracic artery (LITA) has been acknowledged as the first graft of choice for coronary artery bypass grafting (CABG). However, it is still not conclusive which one is the best second graft of choice among right internal thoracic artery, radial artery, right gastroepiploic artery, saphenous vein, and etc., as well as its configuration for CABG.
In our institution, saphenous vein has been primarily used for the second graft and we have harvested it with 'No touch technique'. We have been demonstrated the excellent long-term patency of this 'No touch saphenous vein' in many studies. However, it is still unknown which configuration is the better strategy for the saphenous vein as a Y-composite graft based on the left internal thoracic artery versus an aortocoronary conduit. Thus, we aimed to evaluate morphologic change of saphenous vein graft by 1-year intravascular ultrasound (IVUS) study and angiographic patency results between Y-composite graft and aortocoronary conduit.
The enrolled patient underwent routine sternotomy, and left internal thoracic artery (LITA) and saphenous vein (SV) are harvested. After harvest, the patient is randomized to Y-composite group or aortocoronary group.
For Y-composite group, SV is anastomosed to LITA as Y-composite fashion. Then, LITA is anastomosed to left anterior descending artery. SV is anastomosed to the rest of the target vessels with sequential anastomosis technique (e.g. diagonal branch, obtuse marginal branch, posterolateral branch and posteriori descending artery).
For aortocoronary group, LITA is anastomosed to left anterior descending artery. Then, SV is anastomosed to ascending aorta using proximal anastomosis assist device without clamping the aorta. SV is anastomosed to the rest of the target vessels with sequential anastomosis technique (e.g. diagonal branch, obtuse marginal branch, posterolateral branch and posteriori descending artery).
After completion of anastomoses, residual portion of distal SV is collected for microscopic evaluation and measurement of intima-media thickness.
At the 1-year follow-up, IVUS study, in addition to coronary angiography, is performed to evaluate the morphologic changes and measure intima-media thickness of the saphenous vein graft.
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The saphenous vein is anastomosed to the middle portion of the left internal thoracic artery as Y-composite fashion. Then, left anterior descending artery, if targeted, is bypassed with left internal thoracic artery. Other native coronary arterial targets are bypassed with saphenous vein graft.
Procedure: graft configuration in coronary artery bypass grafting
The saphenous vein is anastomosed to the ascending aorta as aortocoronary fashion. Then, left anterior descending artery, if targeted, is bypassed with left internal thoracic artery. Other native coronary arterial targets are bypassed with saphenous vein graft.
Procedure: graft configuration in coronary artery bypass grafting
Saphenous vein could be used as Y-composite graft or aortocoronary conduit during coronary artery bypass grafting
Intima-media thickness (IMT)
Intima-media thickness measured by intravascular ultrasound (IVUS)
Time frame: at postoperative 1 year
Lumen diameter (LD)
Lumen diameter measured by intravascular ultrasound (IVUS)
Time frame: at postoperative 1 year
Graft patency
Graft patency measured by coronary angiography
Time frame: at postoperative 1 year
All cause mortality
all deaths from any cause
Time frame: at postoperative 1 year
Cardiac death
Any death related to cardiac events, including sudden death during follow-up
Time frame: at postoperative 1 year
Target vessel revascularization
The number of patients who received any intervention performed for the previously bypassed target vessel during follow-up
Time frame: at postoperative 1 year
Reintervention
The number of patients who received any coronary intervention performed during follow-up due to the coronary artery disease
Time frame: at postoperative 1 year
Plan to share: No — Individual participant data will not be shared because it is not allowed by our Institutional Review Board.
No publications or documents are linked to this record.
This study is completed, as verified in Apr 2024. You cannot join it, but the record below documents what was studied.
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Ho Young Hwang