VEST Venous Graft External Support Pivotal Study (VEST Pivotal)
Primary Purpose
Coronary Artery Disease
Status
Active
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
VEST
Coronary artery bypass vein grafts
Sponsored by
About this trial
This is an interventional prevention trial for Coronary Artery Disease focused on measuring Coronary artery bypass
Eligibility Criteria
Inclusion Criteria:
- Signed informed consent, inclusive of release of medical information, and Health Insurance Portability and Accountability Act (HIPAA) documentation.
- Age 21 years or older.
- Planned and scheduled on-pump CABG.
- Two or more vein grafts to native vessels having at least 75% stenosis and comparable runoff.
- IMA graft indicated for the LAD. Additional arterial grafts may be considered based on practice guidelines.
- 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:
- Concomitant non-CABG cardiac surgical procedure.
- Prior cardiac surgery.
- Emergency CABG surgery.
- Contraindication for on-pump CABG with cardioplegic arrest (e.g. severely calcified aorta).
- Calcification at the intended anastomotic sites, as assessed upon opening of the chest and before randomization.
- Severe vein varicosity as assessed after vein harvesting and before randomization.
- History of clinical stroke within 3 months prior to randomization.
- Severe renal dysfunction (Cr>2.0 mg/dL).
- Documented or suspected untreated diffuse peripheral vascular disease such as: carotid stenosis or claudication of the extremities.
- Concomitant life-threatening disease likely to limit life expectancy to less than two years.
- Inability to tolerate or comply with required guideline-based post-operative drug regimen (antiplatelet plus statin) and/or inability to take aspirin.
- Inability to comply with required follow-ups including angiographic imaging methods (e.g. contrast allergy).
- Concurrent participation in an interventional (drug or device) trial.
Sites / Locations
- University of Southern California
- Lutheran Hospital of Indiana
- University of Maryland Baltimore
- Mayo Clinic
- Dartmouth-Hitchcock Medical Center
- Mount Sinai St Luke's
- New York Presbyterian Hospital/Columbia University Medical Center
- Montefiore Medical Center
- Duke University Medical Center
- WakeMed Health & Hospitals
- Cleveland Clinic
- Hospital of the University of Pennsylvania
- Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano
- University of Virginia
- London Health Sciences Centre, University Hospital
- Institut de Cardiologie de Montréal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
VEST supported vein graft
Standard of care vein grafts
Arm Description
Coronary artery bypass vein graft supported with the VEST implant
Coronary artery bypass vein grafts
Outcomes
Primary Outcome Measures
Intimal hyperplasia area/graft occlusion
Intimal hyperplasia (plaque+media) area [mm2] as assessed by IVUS at 12 months. Occluded vessels are accounted for in the analysis of the primary endpoint
Secondary Outcome Measures
Lumen diameter uniformity
Lumen diameter uniformity, assessed by angiography for each graft separately and expressed by the Fitzgibbon classification (22), on a 3-point ordinal scale
vein graft failure
Graft Failure (≥50% stenosis) by cardiac angiography
Full Information
NCT ID
NCT03209609
First Posted
July 4, 2017
Last Updated
May 2, 2023
Sponsor
Vascular Graft Solutions Ltd.
Collaborators
International Center for Health Outcomes and Innovation Research
1. Study Identification
Unique Protocol Identification Number
NCT03209609
Brief Title
VEST Venous Graft External Support Pivotal Study
Acronym
VEST Pivotal
Official Title
A Multi-center, Randomized, Within-subject-controlled, Open Label Study of the Safety and Effectiveness of VEST, Venous External Support
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
January 9, 2018 (Actual)
Primary Completion Date
September 29, 2020 (Actual)
Study Completion Date
June 1, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vascular Graft Solutions Ltd.
Collaborators
International Center for Health Outcomes and Innovation Research
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
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
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.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease
Keywords
Coronary artery bypass
7. Study Design
Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
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.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
224 (Actual)
8. Arms, Groups, and Interventions
Arm Title
VEST supported vein graft
Arm Type
Experimental
Arm Description
Coronary artery bypass vein graft supported with the VEST implant
Arm Title
Standard of care vein grafts
Arm Type
Active Comparator
Arm Description
Coronary artery bypass vein grafts
Intervention Type
Device
Intervention Name(s)
VEST
Intervention Description
External support for vein grafts, cobalt chrome braid
Intervention Type
Procedure
Intervention Name(s)
Coronary artery bypass vein grafts
Intervention Description
Bypass coronary arteries with autologous saphenous vein grafts
Primary Outcome Measure Information:
Title
Intimal hyperplasia area/graft occlusion
Description
Intimal hyperplasia (plaque+media) area [mm2] as assessed by IVUS at 12 months. Occluded vessels are accounted for in the analysis of the primary endpoint
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Lumen diameter uniformity
Description
Lumen diameter uniformity, assessed by angiography for each graft separately and expressed by the Fitzgibbon classification (22), on a 3-point ordinal scale
Time Frame
1 year
Title
vein graft failure
Description
Graft Failure (≥50% stenosis) by cardiac angiography
Time Frame
1 year
Other Pre-specified Outcome Measures:
Title
MACCE
Description
Major adverse cardiac and cerebrovascular events
Time Frame
annually over 5 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Signed informed consent, inclusive of release of medical information, and Health Insurance Portability and Accountability Act (HIPAA) documentation.
Age 21 years or older.
Planned and scheduled on-pump CABG.
Two or more vein grafts to native vessels having at least 75% stenosis and comparable runoff.
IMA graft indicated for the LAD. Additional arterial grafts may be considered based on practice guidelines.
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:
Concomitant non-CABG cardiac surgical procedure.
Prior cardiac surgery.
Emergency CABG surgery.
Contraindication for on-pump CABG with cardioplegic arrest (e.g. severely calcified aorta).
Calcification at the intended anastomotic sites, as assessed upon opening of the chest and before randomization.
Severe vein varicosity as assessed after vein harvesting and before randomization.
History of clinical stroke within 3 months prior to randomization.
Severe renal dysfunction (Cr>2.0 mg/dL).
Documented or suspected untreated diffuse peripheral vascular disease such as: carotid stenosis or claudication of the extremities.
Concomitant life-threatening disease likely to limit life expectancy to less than two years.
Inability to tolerate or comply with required guideline-based post-operative drug regimen (antiplatelet plus statin) and/or inability to take aspirin.
Inability to comply with required follow-ups including angiographic imaging methods (e.g. contrast allergy).
Concurrent participation in an interventional (drug or device) trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Puskas, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Daniel Goldstein, MD
Organizational Affiliation
Montefiore Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Lutheran Hospital of Indiana
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
46804
Country
United States
Facility Name
University of Maryland Baltimore
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55902
Country
United States
Facility Name
Dartmouth-Hitchcock Medical Center
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States
Facility Name
Mount Sinai St Luke's
City
New York
State/Province
New York
ZIP/Postal Code
10025
Country
United States
Facility Name
New York Presbyterian Hospital/Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Montefiore Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States
Facility Name
WakeMed Health & Hospitals
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27610
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Hospital of the University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano
City
Plano
State/Province
Texas
ZIP/Postal Code
75093
Country
United States
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
London Health Sciences Centre, University Hospital
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5A5
Country
Canada
Facility Name
Institut de Cardiologie de Montréal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H1T 1C8
Country
Canada
Facility Name
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval
City
Québec City
State/Province
Quebec
ZIP/Postal Code
G1V 4G5
Country
Canada
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
35675092
Citation
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.
Results Reference
derived
Learn more about this trial
VEST Venous Graft External Support Pivotal Study
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