Rationale and design of a multicenter randomized trial to compare the graft patency between no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery

Wang, Xinqiang; Tian, Meice; Zheng, Zhe; Gao, Huawei; Wang, Yang; Wang, Liqing; Hu, Shengshou

doi:10.1016/j.ahj.2018.11.011

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…Patients who underwent isolated CABG at 7 tertiary hospitals in China were randomly assigned to 2 groups of vein harvesting techniques: the no-touch technique or the conventional approach. The protocol of the trial was published previously 24 and the study was approved by the institutional review board at all participating hospitals. Informed consent was obtained from all participants.…”

Section: Methods Trial Designmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Methods Trial Designmentioning

confidence: 99%

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

et al. 2021

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“…In China, Wang et al randomly assigned 2,655 patients undergoing CABG to the no-touch or conventional group and reported that the former had significantly lower rates of vein graft occlusion than the latter at both 3 months (2.8% vs. 4.8% ; p < 0.001) and 12 months (3.7% vs. 6.5% ; p < 0.001). Angina recurrence was also less common in the no-touch group at 12 months (2.3% vs. 4.1%: p < 0.01) 42,43) .…”

Section: No-touch Techniquementioning

confidence: 88%

Saphenous Vein Graft

Komiya

2022

Journal of Coronary Artery Disease

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Sixty years have passed since René Favaloro of Johns HopkinsUniversity established coronary artery bypass grafting (CABG) using a saphenous vein graft (SVG). Atherosclerotic changes develop in the SVGs at 2-5 years after surgery and the estimated rate of occlusion is as high as 42% after a mean follow-up period of 7.5 years 1) . The growing interest in internal mammary arterial grafting, as well as the accumulation of supporting evidence, has resulted in the adoption of radial and gastroepiploic arteries, enabling total arterial revascularization. Data of isolated CABG performed in 2015-2016 and registered in the Japan Cardiovascular Surgery Database indicated that all arterial graft strategies were used in 25% of elective CABG patients 2) . In contrast, only 10-20% of patients undergoing CABG surgery in Europe and approximately 5% of patients undergoing CABG surgery in the USA undergo multi-arterial grafting 3) . Thus, the role of the SVG in CABG remains unclear. This review article aimed to summarize the relevant literature focusing on SVG use in CABG. Conventional SVG harvestThe open technique is the method most commonly used to harvest the SVG. This approach involves identifying and exposing the saphenous vein using a longitudinal incision. The adventitial layers and surrounding connective tissue are cleared meticulously, while the side branches are ligated or clipped to maintain a safe distance from the vein without narrowing the lumen. When the required length is achieved, the vein is distally cannulated, gently distended with a solution to test for any remaining leaks or untreated side branches, and treated if necessary. The vein is stored at room temperature in saline, heparinized blood, or another storage solution. Early occlusionApproximately 3-12% of SVG procedures fail before hospital discharge. Early failure is attributed to technical factors (graft trauma during harvest, anastomotic failure), conduit-related fac-KEY WORDS: bypass grafting, no-touch, saphenous vein

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“…The patients' hyperlipidemia leads to massive lipid deposition on the vascular endothelium, causing proliferation and calcification of endothelial cells, resulting in gradual narrowing or even occlusion of the lumen. Dyslipidemia can be reflected in increased TG, TC and LDL-C levels and decreased HDL-C level [9] . All lipid regulation guidelines stipulate that the main purpose of lowering blood lipids is to reduce LDL-C and TC levels.…”

Section: Clinical Datamentioning

confidence: 99%

Clinical Efficacy of Atorvastatin Combined with Ezetimibe in Preventing Restenosis after Coronary Artery Bypass Grafting

Wei¹,

Wang²,

Wang³

et al. 2022

IJPS

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Wei et al.: Efficacy of Atorvastatin Combined with Ezetimibe in Preventing RestenosisTo investigate the clinical efficacy of atorvastatin combined with ezetimibe in preventing restenosis after coronary artery bypass grafting. Total 100 patients in Tangshan Workers' Hospital were randomly divided into observation group and control group. The control group received 100 mg aspirin, 75 mg clopidogrel and atorvastatin 20 mg once a day. The observation group was given 10 mg ezetimibe once a day in addition to the above drugs. The venous diameter, blood lipid level changes, inflammatory response, quality of life, adverse reactions and treatment effects were assessed. After treatment for 6 mo, hypersensitive C-reactive protein and interleukin-6 levels were lower in observation group than control group. Total cholesterol, triglyceride and low-density lipoprotein cholesterol levels were lower and high-density lipoprotein cholesterol level was higher in observation group than control group. The observation group exhibited higher rates of vein garft stenosis improvement, lower rates of disease progression, lower incidence of major adverse cardiovascular events and higher 36-Item Short-Form Health survey scores than control group. The efficacy of ezetimibe combined with atorvastatin in treating restenosis after coronary artery bypass grafting is good, which also controls blood lipids with low incidence of adverse reactions.

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Rationale and design of a multicenter randomized trial to compare the graft patency between no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery

Cited by 12 publications

References 25 publications

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

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

Saphenous Vein Graft

Clinical Efficacy of Atorvastatin Combined with Ezetimibe in Preventing Restenosis after Coronary Artery Bypass Grafting

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