VEST Venous Graft External Support Pivotal Study

NCT ID: NCT03209609

Last Updated: 2025-02-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

224 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-09

Study Completion Date

2024-09-25

Brief Summary

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Prospective, multi-center, randomized, within-subject-controlled , trial, enrolling patients with multi vessel atherosclerotic coronary artery disease, scheduled to undergo SVG CABG with arterial grafting of IMA to LAD and two or more saphenous vein grafts. In each patient, one SVG bypass will be randomized to be supported by the VEST, while another will not be supported and serve as control. Thus, the full cohort will provide a basis for comparison between two sets of SVGs: A VEST supported set; and an unsupported set.

Detailed Description

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Clinical significance:

Coronary artery bypass grafting (CABG) remains the gold standard treatment for patients with multi-vessel coronary artery disease. Despite the proposed benefits of multiple arterial grafts, autologous saphenous vein grafts (SVGs) are still the most frequently used bypass conduits in CABG. Progressive SVG failure after CABG remains a key limitation to the long-term success of surgery.

Objective:

Coronary artery bypass grafting (CABG) remains the gold standard treatment for patients with multi-vessel coronary artery disease. Despite the proposed benefits of multiple arterial grafts, autologous saphenous vein grafts (SVGs) are still the most frequently used bypass conduits in CABG. Progressive SVG failure after CABG remains a key limitation to the long-term success of surgery.

Study design:

Prospective, multi-center, randomized, within-subject-controlled , trial, enrolling patients with multi vessel atherosclerotic coronary artery disease, scheduled to undergo SVG CABG with arterial grafting of IMA to LAD and two or more saphenous vein grafts. In each patient, one SVG bypass will be randomized to be supported by the VEST, while another will not be supported and serve as control. Thus, the full cohort will provide a basis for comparison between two sets of SVGs: A VEST supported set; and an unsupported set.

Conditions

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Coronary Artery Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

In each patient, one SVG bypass will be randomized to be supported by the VEST, while another will not be supported and serve as control.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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VEST supported vein graft

Coronary artery bypass vein graft supported with the VEST implant

Group Type EXPERIMENTAL

VEST

Intervention Type DEVICE

External support for vein grafts, cobalt chrome braid

Coronary artery bypass vein grafts

Intervention Type PROCEDURE

Bypass coronary arteries with autologous saphenous vein grafts

Standard of care vein grafts

Coronary artery bypass vein grafts

Group Type ACTIVE_COMPARATOR

Coronary artery bypass vein grafts

Intervention Type PROCEDURE

Bypass coronary arteries with autologous saphenous vein grafts

Interventions

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VEST

External support for vein grafts, cobalt chrome braid

Intervention Type DEVICE

Coronary artery bypass vein grafts

Bypass coronary arteries with autologous saphenous vein grafts

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Signed informed consent, inclusive of release of medical information, and Health Insurance Portability and Accountability Act (HIPAA) documentation.
2. Age 21 years or older.
3. Planned and scheduled on-pump CABG.
4. Two or more vein grafts to native vessels having at least 75% stenosis and comparable runoff.
5. IMA graft indicated for the LAD. Additional arterial grafts may be considered based on practice guidelines.
6. Appropriately sized and accessible target coronary arteries, with a minimum diameter of 1.5 mm and adequate vascular bed (without significant distal stenosis), as assessed by pre-operative cardiac angiography and verified by diameter gauging intraoperatively.

Exclusion Criteria

1. Concomitant non-CABG cardiac surgical procedure.
2. Prior cardiac surgery.
3. Emergency CABG surgery.
4. Contraindication for on-pump CABG with cardioplegic arrest (e.g. severely calcified aorta).
5. Calcification at the intended anastomotic sites, as assessed upon opening of the chest and before randomization.
6. Severe vein varicosity as assessed after vein harvesting and before randomization.
7. History of clinical stroke within 3 months prior to randomization.
8. Severe renal dysfunction (Cr\>2.0 mg/dL).
9. Documented or suspected untreated diffuse peripheral vascular disease such as: carotid stenosis or claudication of the extremities.
10. Concomitant life-threatening disease likely to limit life expectancy to less than two years.
11. Inability to tolerate or comply with required guideline-based post-operative drug regimen (antiplatelet plus statin) and/or inability to take aspirin.
12. Inability to comply with required follow-ups including angiographic imaging methods (e.g. contrast allergy).
13. Concurrent participation in an interventional (drug or device) trial.
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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International Center for Health Outcomes and Innovation Research

OTHER

Sponsor Role collaborator

Vascular Graft Solutions Ltd.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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John Puskas, MD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Daniel Goldstein, MD

Role: PRINCIPAL_INVESTIGATOR

Montefiore Medical Center

Locations

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University of Southern California

Los Angeles, California, United States

Site Status

Lutheran Hospital of Indiana

Fort Wayne, Indiana, United States

Site Status

University of Maryland Baltimore

Baltimore, Maryland, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

Mount Sinai St Luke's

New York, New York, United States

Site Status

New York Presbyterian Hospital/Columbia University Medical Center

New York, New York, United States

Site Status

Montefiore Medical Center

New York, New York, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

WakeMed Health & Hospitals

Raleigh, North Carolina, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Hospital of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano

Plano, Texas, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

London Health Sciences Centre, University Hospital

London, Ontario, Canada

Site Status

Institut de Cardiologie de Montréal

Montreal, Quebec, Canada

Site Status

Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval

Québec, Quebec, Canada

Site Status

Countries

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United States Canada

References

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Goldstein DJ, Puskas JD, Alexander JH, Chang HL, Gammie JS, Marks ME, Iribarne A, Vengrenyuk Y, Raymond S, Taylor BS, Yarden O, Orion E, Dagenais F, Ailawadi G, Chu MWA, DiMaio JM, Narula J, Moquete EG, O'Sullivan K, Williams JB Jr, Crestanello JA, Jessup M, Rose EA, Scavo V, Acker MA, Gillinov M, Mack MJ, Gelijns AC, O'Gara PT, Moskowitz AJ, Bagiella E, Voisine P. External Support for Saphenous Vein Grafts in Coronary Artery Bypass Surgery: A Randomized Clinical Trial. JAMA Cardiol. 2022 Aug 1;7(8):808-816. doi: 10.1001/jamacardio.2022.1437.

Reference Type DERIVED
PMID: 35675092 (View on PubMed)

Other Identifiers

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CD0131

Identifier Type: -

Identifier Source: org_study_id

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