No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study

Abstract

BackgroundIn the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch (NT) were higher than those obtained by the conventional (CON). In the past, NT harvesting was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analyzed the safety and effectiveness of sequential vein grafts using NT harvesting in off-pump CABG.MethodsFrom 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, post-operative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups.ResultsThere was no significant difference in the patency rate of sequential venous grafts between the two groups 1 year after the operation either before [NT: 7.1% (10/141) vs. CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs. CON: 7.3% (9/124), p = 0.971]. There was no significant difference in the composite clinical endpoint between the two groups either before [NT: 3 (2.3%) vs. CON: 9 (2.8%), p = 1.000] or after matching [NT: 3 (2.3%) vs. CON: 3 (2.5%), p = 1.000]. There were differences in leg wound complications between the two groups both before [NT: 9 (6.9%) vs. CON: 6 (1.9%), p = 0.007] and after matching [NT: 9 (6.9%) vs. CON: 2 (1.7%), p = 0.043].ConclusionsThe application of the NT harvesting in off-pump CABG with sequential vein grafts is safe and effective. NT method has disadvantages in leg wound.

Strategies to Minimize Sternal and Leg Wound Complications after Coronary Artery Bypass Grafting Using No-Touch Saphenous Vein Grafts

“…Leg wound complication rates have been reported to be 6% to 23% in the NT SV groups, which were higher than in the conventionally harvested SV groups. 13,14) To minimize the development of wound complications after NT SV harvest, preoperative evaluation of lower limb vascular status, selection of an adequate vein, creation of a precise incision, careful harvest, placement of a drain in the vein harvest site, and meticulous skin wound closure were performed in this study. 16) We believe that prevention of serosanguinous fluid and blood collection and alleviating dead space by using an appropriate drain are mandatory for decreasing the potential risk of wound complications.…”

“… 10 – 12 ) However, higher leg wound complication rates were reported in patients who received NT SV. 13 , 14) …”

“…[10][11][12] However, higher leg wound complication rates were reported in patients who received NT SV. 13,14) The aims of the present study were (1) to examine the sternal and leg wound complication rates and (2) to assess the strategies to minimize the sternal and leg wound complications in CABG patients who received NT SV at a newly opened cardiac surgical program.…”

Skin Closure After No-Touch Saphenous Vein Harvest: Strategies to Minimize Wound Complications

“…Despite improved SV conduit patency rates, it is possible that no-touch SV harvest may cause greater leg swelling and increased wound complications by disruption of more tissues, including venous and lymphatic channels [ 4 ] . Leg wound complication rates have been reported to be 6% to 23% in the no-touch SV groups, which were higher than in the conventionally harvested SV groups [ 4 - 6 ] . Strategies to minimize leg wound complications after no-touch SV harvest based on our experience are discussed below.…”