Bypass breakthrough?

St. Luke’s Medical Center in Milwaukee and Waukesha Memorial Hospital were two of 145 hospitals in the nation that participated in a recent study to prolong the lifespan of vein grafts used in coronary bypass surgery.
A product called E2F Decoy, developed by Corgentech Inc. of South San Francisco, Calif., is designed to prevent abnormal cell growth that causes blockages in vein grafts used for coronary bypass surgeries.
In most coronary bypass surgeries, a piece of a patient’s vein from his or her calf is removed and used to bypass the blood flow around a blockage in a coronary artery. With E2F Decoy, the vein graph is soaked for 10 minutes under pressure in a solution before it is attached to the heart.
"The only difference in the procedure is the treatment of the vein graft," Seifert said.
E2F Decoy helps the vein graft adapt to the higher pressure of arterial blood flow, which can cause the vein grafts to harden and thicken until they are blocked.
"If this study proves this is a beneficial treatment for vein graphs, I think it’s going to change the way we look at vein graphs," said Dr. Paul Seifert, cardiac surgeon at Waukesha Memorial Hospital. "We believe this innovative treatment has the potential to improve bypass surgery as a long-term solution for patients."
Each year, about 500,000 coronary bypass surgeries are performed in the United States. Coronary bypass surgery is an affective treatment for blocked coronary arteries, but many of the vein grafts used for the procedure fail over time. Seifert said about 30% of vein grafts used for bypass surgeries do not last 10 years.
About 20% to 30% of the vein grafts in bypass surgeries have significant blockage within one year, said Dr. Monica McDonald, cardiothoracic surgeon at St. Luke’s.
Coronary bypass surgery patients who experience blockages in their vein grafts need to undergo another procedure to address the problem, which often is another bypass surgery.
Initial indications are that E2F Decoy may dramatically reduce the failure rate of vein grafts.
"Clinical trial results of E2F Decoy presented in 2001 showed a 30% reduction in vein graft failure among patients undergoing coronary bypass grafting who were treated with E2F Decoy as compared to a placebo," said Kathryn Allen, spokeswoman for ProHealth Care, which operates Waukesha Memorial Hospital.
If E2F Decoy can prolong the lifespan of vein grafts, it will reduce the frequency patients will have to go back to the hospital for additional surgeries and thereby reduce medical costs.
"Helping reduce a patient’s risk (of blockage) and reduce the need for future procedures is what this study is all about," McDonald said. "Research like this has the potential to make our initial bypass procedure even stronger in the long run, and that benefits patients."
For the study, coordinated by the Society of Thoracic Surgeons and Duke University, 3,000 volunteer coronary bypass patients received either a vein graft treated with E2F Decoy or a vein graft treated in a placebo.
St. Luke’s had 23 patients who participated in the study. Waukesha Memorial had 16. The Appleton Heart Institute at Appleton Medical Center and Wausau Hospital also participated in the study.
"We’re always looking for things that are going to advance the care of the patient," Seifert said. "This seemed like a promising study to get involved in."
The first bypass surgeries done with E2F Decoy and the placebo were done in late 2002. It is too early to be sure if E2F Decoy is a complete success.
"The patients are just now coming to the one-year mark," Seifert said. "(But) so far, we haven’t seen any failure or problems with the grafts."
April 30, 2004 Small Business Times, Milwaukee