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J Thorac Cardiovasc Surg 2007;133:1119
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria

I appreciate the letter by Rosenfeldt and colleagues, and I fully agree that prevention of vein graft disease is the first step to improve vein graft longevity. In addition to using a surgical no-touch technique, Souza and colleagues¹ recently presented long-term data on the superior performance of saphenous veins that were harvested with their surrounding tissue. The ischemic time of the harvested vein and the type of storage medium play a role too. Furthermore, we have to keep in mind that the greater the target vessel diameter the better the vein graft longevity. Rosenfeldt and colleagues focus on the problem of dilation of the saphenous veins before implantation, which inevitably leads to endothelial injury (and stretch-induced apoptosis of vascular cells). Their concept of pharmacologic (instead of mechanical) dilation of the saphenous veins in coronary artery bypass grafting seems to be a rational concept. However, single preventive or therapeutic strategies against vein graft disease are insufficient. Thus, a combination of measurements seems worthwhile. A variety of models of vein graft disease have taught us pathologic features of vein graft disease.² Nevertheless, only a couple of therapeutic interventions (systemic pharmacotherapy) have reached clinical practice (mainly aspirin and statins). Thus, an additional local therapy of the vein graft might be an attractive option to fulfill the armamentarium of the cardiac surgeon against vein graft degeneration (Figure 1).

View larger version (16K): [in this window] [in a new window]   Figure 1. Strategies to fight vein graft disease.

References

1. Souza DS, Johannson B, Bojo L, et al. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373-378.[Abstract/Free Full Text]
   
2. Schachner T, Laufer G, Bonatti J. In vivo (animal) models of vein graft disease. Eur J Cardiothorac Surg 2006;30:451-463.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas Schachner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schachner, T. Search for Related Content PubMed Articles by Schachner, T. Related Collections Coronary disease Related Article