The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG), yet its limited long-term patency adversely affects patient outcomes. SVG failure is a multistage pathological process, characterized by early thrombosis, intermediate intimal hyperplasia, and late atherosclerotic degeneration. These changes are driven by endothelial dysfunction induced by ischemia-reperfusion and mechanical injury, smooth muscle cell phenotypic modulation, inflammatory activation, and conventional cardiovascular risk factors. Preventive strategies for SVG failure have increasingly focused on both surgical and pharmacological optimization. Surgical approaches include appropriate target vessel and anastomotic site selection, refinement of SVG harvesting techniques (notably the no-touch technique and endoscopic vein harvesting), optimization of graft configurations, and routine intraoperative graft flow assessment. Postoperative secondary prevention is essential, as antithrombotic and lipid-lowering therapies have been shown to reduce SVG occlusion. In addition, emerging therapies, including gene-based interventions, antiproliferative agents, novel graft preservation solutions, and external vein graft supports, show promise in improving SVG durability. Integrated multimodal strategies may further reduce SVG failure and improve long-term outcomes after CABG. This article provides a review of researches related to SVG failure, including the mechanisms of failure, intraoperative preventive measures, pharmacological prevention, and recent advances in treatment, aiming to offer insights for clinical diagnosis, treatment and future studies.
ObjectiveTo evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis.MethodsA total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR.ResultsThe median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05).ConclusionFor patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.