No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After Coronary Artery Bypass Grafting Surgery: Multicenter Randomized, Controlled Trial

Abstract

Background: Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare. Methods: From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient. Results: During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41–0.80]; P <0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41–0.76]; P <0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35–0.85]; P <0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85–3.52]; P <0.001). Conclusions: Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03126409.

Clinical Outcomes After Surgical Revascularization Using No-Touch Versus Conventional Saphenous Vein Grafts: Mid-Term Follow-Up of Propensity Score Matched Cohorts

“…Both covariates were omitted from the propensity score model as they have been reported to be affected by the treatment of interest in previous randomized controlled trials. 14,15,27 Propensity score matching resulted in 923 pairs of C-SVG and NT-SVG patients. Baseline characteristics of the propensity matched cohorts were almost identical.…”

“…2,4,5,7,12,13 Data from 2 recent multicenter randomized controlled trials provide conflicting evidence regarding the proposed superior longevity of NT-SVGs. 14,15 Results from the ongoing SWEDEGRAFT multicenter randomized controlled trial are pending. 16 It is important to consider that SVG failure may not represent a valid surrogate for clinical outcome after CABG, as the impact of SVG failure on clinical outcome remains unclear.…”

The “No-touch” Harvesting Technique Revives the Position of the Saphenous Vein as an Important Conduit in CABG Surgery: 30-year Anniversary

“…Initially there appeared little acceptance for this technique with it being used solely in the department of thoracic and cardiac surgery at Örebro University Hospital, where it was developed. Following publication of both the randomized clinical trials and the basic science studies, considerable interest has been raised worldwide whereby the NT technique is recognized and has been adopted in many countries, especially in Sweden [ 12 , 13 ] ), Japan [ 14 ] , China [ 15 ] , and South Korea [ 16 ] . Currently, two large randomized multicenter trials are ongoing to evaluate the NT technique.…”

“…Currently, two large randomized multicenter trials are ongoing to evaluate the NT technique. The first one is being performed in China, which included 2,655 patients and the one-year results was recently published [ 15 ] . The second similar ongoing randomized trial is in Sweden and 900 patients were included [ 13 ] .…”

Commentary: The saphenous vein in coronary artery bypass grafting: Optimizing our workhorse

“…However, as surgical and adjunctive medical therapies continue to improve, so do the outcomes of saphenous conduit. For example, in the recent Graft Patency Between no-touch Vein Harvesting Technique and Conventional Approach in Coronary Artery Bypass Graft Surgery (PATENCY) trial, Tian and colleagues 2 demonstrated early SVG failure rates of 2.8% with no-touch SVG harvest and 4.8% ( P < .001) with conventional SVG harvesting. At 1 year, graft patency was 94.3% in the no-touch SVG group and 93.5% in the conventional harvest group ( P < .001).…”