To Örebro University

oru.seÖrebro University Publications
Change search
Link to record
Permanent link

Direct link
Publications (8 of 8) Show all publications
Ferrari, G., Geijer, H., Cao, Y., Graf, U., Bojö, L., Carlsson, R., . . . Samano, N. (2025). Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts. Perfusion, 40(1), 211-220
Open this publication in new window or tab >>Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts
Show others...
2025 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 40, no 1, p. 211-220Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique.

METHODS: This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis.

RESULTS: The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p < .01), with a subdistribution hazard ratio (SHR) of 0.16 (p = .010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p < .01) with a SHR of 0.53 (p = .017). The short-term results were similar in both groups.

CONCLUSIONS: Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG.

Place, publisher, year, edition, pages
Sage Publications, 2025
Keywords
coronary artery bypass graft, major adverse cardiac events, no-touch, percutaneous coronary intervention, saphenous vein, stent
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-111036 (URN)10.1177/02676591241230012 (DOI)001147222400001 ()38253348 (PubMedID)2-s2.0-85182996475 (Scopus ID)
Funder
Region Örebro County, OLL-935188Region Uppsala, RFR-55691
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2025-02-10Bibliographically approved
Ferrari, G. (2024). Percutaneous coronary intervention in no-touch vein grafts: Clinical and angiographic results. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Percutaneous coronary intervention in no-touch vein grafts: Clinical and angiographic results
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Coronary artery disease is one of the biggest health issues worldwide; it is estimated that cardiovascular diseases cause around 45% of all deaths in Sweden and in the Western world. In a large proportion of cases, the treatment involves a coronary artery bypass grafting (CABG) operation. One of the most commonly-used grafts is the saphenous vein from the leg, but this has the disadvantage of a predisposition to early obstruction, with inter-national literature showing occlusion rates of 15% in the first year and 40% after 10 years.

At the Department of Cardiothoracic and Vascular Surgery at Örebro University Hospital, a method was developed for harvesting the saphenous vein together with the surrounding fat tissue. This technique, called the no-touch technique (NT), has the advantage of reducing damage to the vein during the harvesting, and carries a substantially reduced risk of future occlusion (5% after 18 months and 10% after 8.5 years).

The aim of this dissertation was to evaluate the results of the no-touch technique in comparison to the conventional (C) technique for venous graft harvesting, focusing on patients who received a percutaneous coronary intervention (PCI) in their NT or C ve-nous graft. This study is the first to examine the long-term results of the no-touch tech-nique after stenting of the venous graft.

Paper I was a systematic review and meta-analysis of the international literature re-garding PCI in vein grafts. It included 36 articles covering nearly 15 000 patients in total. Paper II was a retrospective clinical cohort study including 346 patients (67 NT, 279 C) who underwent PCI in a stenosed vein graft, with a mean follow-up time of 6.4 ± 3.7 years. The primary endpoint was in-stent restenosis, and secondary endpoints were major adverse cardiovascular events (MACE) and 1-year re-hospitalization rate. Paper III was a retrospective cohort study analysing all individuals who required clinically-driven coro-nary angiography after CABG. It included 1520 patients (618 NT, 825 C, 77 arterial graft) with a mean follow-up time of 8.4 ± 5.5 years. The patency rate of the vein grafts was compared between the two techniques as primary outcome. Paper IV was a retro-spective cohort study in which individuals who received a PCI in their vein graft (NT or C) were asked to estimate their quality of life using the RAND-36 survey, which consists of eight domains. A total of 165 patients answered the questionnaire (48 NT, 117 C).

The results showed that in comparison to C grafts, NT vein grafts displayed a statisti-cally significantly higher patency rate and statistically significantly lower rates of long-term in-stent restenoses and MACE. Among patients who later required a PCI in the vein graft, those who received a primary NT graft estimated their quality of life as better than those who received a primary C graft. The NT vein graft results in this dissertation were significantly better than results in the international literature, suggesting that use of this technique will have both clinical and economic benefits at both the individual and the community level. Clinical benefits consist of fewer recurrences of angina and myocardial infarction, less risk of needing a new interventional procedure, and improved quality of life. These in turn will create health-economic benefits for the healthcare system.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 54
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 294
Keywords
coronary artery bypass graft, MACE, meta-analysis, health-related quality of life, no-touch, patency, percutaneous coronary intervention, saphenous vein, stent
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-116075 (URN)9789175295657 (ISBN)9789175295664 (ISBN)
Public defence
2024-12-13, Örebro universitet, Campus USÖ, hörsal X1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-09-17 Created: 2024-09-17 Last updated: 2024-11-11Bibliographically approved
Ferrari, G., Loayza, R., Azari, A., Geijer, H., Cao, Y., Carlsson, R., . . . Souza, D. (2024). Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients. Journal of Cardiothoracic Surgery, 19(1), Article ID 570.
Open this publication in new window or tab >>Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients
Show others...
2024 (English)In: Journal of Cardiothoracic Surgery, E-ISSN 1749-8090, Vol. 19, no 1, article id 570Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique.

METHODS: This was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel).

RESULTS: The study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR = 1.8). CONCLUSIONS: The no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts.

CLINICAL TRIAL REGISTRATION: NCT04656366, 7 December 2020.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Coronary artery bypass graft, major adverse cardiac events, no-touch, patency, saphenous vein, stent
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-116473 (URN)10.1186/s13019-024-03057-3 (DOI)001326765400001 ()39354611 (PubMedID)2-s2.0-85205528212 (Scopus ID)
Funder
Örebro UniversityRegion Örebro County, OLL-935188
Available from: 2024-10-03 Created: 2024-10-03 Last updated: 2025-02-10Bibliographically approved
Svedjeholm, R., Ferrari, G., Vanky, F., Friberg, Ö. & Holm, J. (2023). Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II. Acta Anaesthesiologica Scandinavica, 67(10), 1373-1382
Open this publication in new window or tab >>Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II
Show others...
2023 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 67, no 10, p. 1373-1382Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG.

METHODS: A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10-20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes.

RESULTS: We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02).

CONCLUSIONS: Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Copeptin, coronary surgery, diabetes, glutamate, heart failure, myocardial ischaemia, perioperative care
National Category
Surgery Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-106618 (URN)10.1111/aas.14303 (DOI)001020289000001 ()37365871 (PubMedID)2-s2.0-85163038495 (Scopus ID)
Funder
Region Östergötland, RO~796412 RO~693091 RO~610951
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2025-02-10Bibliographically approved
Holm, J., Ferrari, G., Holmgren, A., Vanky, F., Friberg, Ö., Vidlund, M. & Svedjeholm, R. (2022). Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial. PLoS Medicine, 19(5), Article ID e1003997.
Open this publication in new window or tab >>Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial
Show others...
2022 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 19, no 5, article id e1003997Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Animal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG.

METHODS AND FINDINGS: A prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG ± valve procedure and had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat. We studied 303 patients (age 74 ± 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 ± 5,396 ng/L versus 6,452 ± 5,215 ng/L; p = 0.086). One patient died ≤30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed. A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 ± 4,846 ng/L versus 6,824 ± 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data. The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation.

CONCLUSIONS: Infusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation.

TRIAL REGISTRATION: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02592824. European Union Drug Regulating Authorities Clinical Trials Database (Eudra CT number 2011-006241-15).

Place, publisher, year, edition, pages
PLOS, 2022
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-98919 (URN)10.1371/journal.pmed.1003997 (DOI)000836909800001 ()35533197 (PubMedID)2-s2.0-85130486899 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20140633Region Östergötland, RO 796412 RO 693091 RO 610951
Available from: 2022-05-10 Created: 2022-05-10 Last updated: 2025-02-10Bibliographically approved
Ferrari, G., Karlsson, J., Cao, Y., Geijer, H., de Souza, D. R. & Samano, N. (2022). Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts. Brazilian Journal of Cardiovascular Surgery, 37(4), 430-438
Open this publication in new window or tab >>Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts
Show others...
2022 (English)In: Brazilian Journal of Cardiovascular Surgery, ISSN 0102-7638, E-ISSN 1678-9741, Vol. 37, no 4, p. 430-438Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft.

METHODS: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM).

RESULTS: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains.

CONCLUSION: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

Place, publisher, year, edition, pages
Sociedade Brasileira de Cirurgia Cardiovascular, 2022
Keywords
Coronary Artery Bypass, Fatigue, Percutaneous Coronary Intervention, Propensity Score., Quality of Life, Saphenous Vein
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-100713 (URN)10.21470/1678-9741-2021-0576 (DOI)000862466400001 ()35976202 (PubMedID)2-s2.0-85136216148 (Scopus ID)
Funder
Region Örebro County, OLL-935188
Available from: 2022-08-18 Created: 2022-08-18 Last updated: 2024-11-05Bibliographically approved
Ferrari, G., Geijer, H., Cao, Y., de Souza, D. R. & Samano, N. (2021). Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting: a systematic review and meta-analysis. Scandinavian Cardiovascular Journal, 55(4), 245-253
Open this publication in new window or tab >>Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting: a systematic review and meta-analysis
Show others...
2021 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 55, no 4, p. 245-253Article, review/survey (Refereed) Published
Abstract [en]

To investigate the results of percutaneous coronary intervention (PCI) in saphenous vein grafts after coronary artery bypass grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were searched for relevant articles published between 1 January 2000 and 29 February 2020. The PICO (population, intervention, comparison, outcome) model was applied in constructing the clinical question. Two independent researchers performed the literature search. Thirty-six articles were identified and subjected to a quality assessment. The primary outcomes of the meta-analysis were long-term in-stent restenosis and long-term major adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95% CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 ± 1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%; 95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE (15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in better outcomes at least in term of in-stent restenosis, while the benefit of using embolic protection devices was questionable. Conclusions. PCI of a stenosed or occluded saphenous vein graft is a challenge for interventional cardiologists, and is still associated with relatively high rates of restenosis, MACE, and procedural failure. All efforts to enhance the results are warranted, including improved quality of the venous grafts used during CABG. 

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Coronary artery bypass graft, MACE, meta-analysis, percutaneous coronary intervention, saphenous vein
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-90623 (URN)10.1080/14017431.2021.1900598 (DOI)000630402400001 ()33733984 (PubMedID)2-s2.0-85103018461 (Scopus ID)
Note

Funding Agency:

Region Örebro County through the regional research board OLL-812871

Available from: 2021-03-22 Created: 2021-03-22 Last updated: 2025-02-10Bibliographically approved
Ferrari, G., Geijer, H., Samano, N. & de Souza, D. R. (2019). PCI in saphenous vein graft after CABG: a review of the international literature. In: Book of abstracts: Nobel Day's Festivities 2019, Örebro University, 2019. Paper presented at Nobel Day's Festivities 2019, Örebro, Sweden, 9 December, 2019. School of Health Sciences and School of Medical Sciences, Örebro University, Article ID 7.
Open this publication in new window or tab >>PCI in saphenous vein graft after CABG: a review of the international literature
2019 (English)In: Book of abstracts: Nobel Day's Festivities 2019, Örebro University, 2019, School of Health Sciences and School of Medical Sciences, Örebro University , 2019, article id 7Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background/objectives: To review the international literature about the use of Percutaneous Coronary Intervention (PCI) in vena saphena magna graft after a Coronary Artery Bypass Grafting (CABG).

Methods: We reviewed, from three different databases, the recent international literature (published between January 1, 2000 and December 31, 2018) regarding the use of PCI invenous grafts. Two independent researchers performed the literature search, designed after a PICO model. Forty articles were selected and a quality assessment was performed.

Results: We noticed a high percentage of short and long-term cardiac events. The peri-procedural failure rate, due to residual stenos, had a mean value around 10%. The 30-days MACE (major adverse cardiac event) had a mean value of 6-7%, with the lower rates associated with the use of embolic protection devices. The MACE rates at 1 year reported were above 10% for most reports (up to over 30%; mean 16%), with better results after the use of a drug-eluting stent (DES) instead of a bare-metal stent. The long-term MACE (2-5 years) reported was high in all studies, with values ranging between 18% and 58%, with target vessel revascularization rates between 9% and 44%. The benefits of DES no longer remain in the long term.

Conclusions: The percutaneous intervention of an occluded or stenosed saphenous vein graftis a challenge for the angiographer and is still associated with high rates of failure, MACE and restenosis. The key of the success of the procedure seems to be to optimize the quality of the venous graft itself.

Place, publisher, year, edition, pages
School of Health Sciences and School of Medical Sciences, Örebro University, 2019
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:oru:diva-98972 (URN)978-91-87789-30-4 (ISBN)
Conference
Nobel Day's Festivities 2019, Örebro, Sweden, 9 December, 2019
Available from: 2022-05-12 Created: 2022-05-12 Last updated: 2025-02-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8786-2188

Search in DiVA

Show all publications