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Eur J Cardiothorac Surg 2002;22:387-396
© 2002 Elsevier Science NL

Review

Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery

Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, 840 South Wood Street, CSB Suite 417 (MC 958), Chicago, IL 60612, USA

Received 10 January 2002; received in revised form 21 March 2002; accepted 18 April 2002.

* Corresponding author. Tel.: +1-312-996-6215; fax: +1-312-996-2013
e-mail: mmassad{at}uic.edu

Coronary artery bypass grafting has been utilized as a beneficial treatment for myocardial ischemic disease for over three decades. Failure of coronary artery venous grafts occurs at a substantial rate and has a large impact on two main endpoints, survival and quality of life. An exhaustive amount of basic research has been generated to delineate possible mechanisms responsible for graft failure and modalities to prevent its occurrence. Although pharmacotherapy exists, insufficient translation has emerged from the bench to the operating room. In this article, we review the literature regarding the current mechanisms and mediators including growth factors, nitric oxide and genetics leading to saphenous vein graft occlusion. The review addresses the current state of affairs and modes for prevention of vein graft failure perioperatively and newer technologies that may help ameliorate this problem in the future.

Key Words: Vein graft failure • Mechanisms • Future directions • Prevention • Coronary artery bypass

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