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Invited Commentary
August 2014

Searching for New Meaning in PREVENT IV?A Project of Ex-Vivo Vein Graft Engineering via Transfection IV Substudy

Author Affiliations
  • 1Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
JAMA Surg. 2014;149(8):805-806. doi:10.1001/jamasurg.2014.106

The mechanisms behind saphenous vein graft failure (VGF) in patients undergoing coronary artery bypass grafting have remained elusive. Sophisticated approaches toward modifying the biology of vein graft endothelium exemplified by the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial1 have repeatedly met with disappointing results. Nevertheless, Harskamp and colleagues2 have identified reduced VGF rates in veins preserved with buffered saline compared with both placebo preservatives (ie, normal saline and blood) used in PREVENT IV. The reduction in VGF rates in the buffered saline group is perhaps made even more significant with the greater use of endoscopic vein harvesting in that group, given that well-designed studies have suggested higher VGF rates in veins harvested with this technique, irrespective of the use of cardiopulmonary bypass.3,4 Furthermore, the reduced quality of vein grafts and target coronary arteries in this group should also have exerted a substantial negative effect on vein graft patency rates.

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