Sequential Saphenous Vein Coronary Bypass Grafting

Journal of Cardiac Surgery

et al. 2021

Background and Aim of the Study: Many studies support that the no-touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the sequential vein graft early expansion in the NT technique during off-pump coronary artery bypass grafting (CABG). This study will explore this issue.Methods: This was a prospective single-center randomized controlled clinical trial. A total of 100 patients undergoing off-pump CABG with the sequential saphenous graft were randomly assigned to two groups: the NT and conventional (CON) groups. Perioperative and postoperative data were collected during the hospital stay. The mean diameter of sequential grafts was measured using cardiac computed tomography angiography 3 months after the operation.Results: There was a significant difference in the average diameter of sequential grafts between the two groups (NT: [2.98 ± 0.42], CON: [3.26 ± 0.51], p = .005). There was no difference in occlusion of sequential venous grafts between the two groups (NT: 4/48 [8.3%], CON: 5/49 [10.2%], p = 1.000). There were differences in surgery time between the two groups (NT: 220 [188,240], CON: 190 [175,230], p = .009). Conclusions:The sequential graft early expansion in the NT technique is not as pronounced as that in the conventional technique, which may have a long-term protective effect on the grafts.cardiac computed tomography angiography (CCTA), conventional saphenous vein graft harvesting, coronary artery bypass grafting (CABG), no-touch saphenous vein graft harvesting, off-pump CABG, sequential saphenous vein graftingThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Section: Discussionmentioning

confidence: 94%

“…Sequential vein grafts can preserve vein length, and off‐pump bypass grafting can accelerate postoperative recovery and reduce the incidence of postoperative complications 16 . Many studies have shown that there is no substantial difference between single vein and sequential vein grafts 17–19 …”

Section: Discussionmentioning

confidence: 99%

The expansion of no‐touch harvesting sequential vein graft after off‐pump coronary artery bypass grafting

Hou

Zhang

Journal of Cardiac Surgery

et al. 2021

“…Pigs can be used to evaluate TEVG growth and plaque formation in short-term studies, while sheep are more suitable for investigating thrombogenicity, calcification, and long-term patency of the grafts, for the reason that sheep develop a very similar lesion of intimal hyperplasia to those found in failed human access grafts and the ovine coagulation system more closely resembles human coagulation than dogs or pigs (Schleimer et al, 2018). Side-toside suturing is sometimes utilized in sequential bypass which sequentially connects 2 or 3 coronary arteries with just one graft (Ji et al, 2018). They provide the most similar physiology to humans and the most convincing results in TEVG researches.…”

Section: Animal Studiesmentioning

confidence: 99%

“…End-to-side suturing is the most common method utilized in cardiovascular surgery. Side-toside suturing is sometimes utilized in sequential bypass which sequentially connects 2 or 3 coronary arteries with just one graft (Ji et al, 2018). Conversely, end-to-end suturing is not that comparable with clinical surgery.…”

Section: Animal Studiesmentioning

confidence: 99%

Strategies in cell‐free tissue‐engineered vascular grafts

Yuan

Chen

J Biomedical Materials Res

et al. 2019

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in the world, among which coronary artery diseases (CAD) are the most common type of CVD. Coronary artery bypass grafting (CABG) using autologous vein and artery grafts is the typical surgical intervention for CAD patients. However, for patients whose autologous grafts are not available, there are no appropriate substitutes for vascular grafts. Investigation of tissue-engineered vascular graft (TEVG) has persisted over decades with significant advancement, utilizing different types of biomaterials.In the past two decades, a great number of studies based on cell-seeding strategies were reported. However, limitations of cell-based strategies made clinical application difficult. With the understanding of stem cells and tissue remodeling process, strategies without cell-seeding emerged as potential methods to achieve in situ regeneration.A cell-free graft may recruit host cells and guide their participation in vascular remodeling. The grafts modified by bio-active molecules showed good results in promoting in situ regeneration and exhibited potential to make the vascular grafts off-the-shelf.In this review, the strategies for cell-free TEVG manufacturing were discussed, including the materials for fabricating TEVGs, the methods of functionalization to promote in situ regeneration, the challenges researchers faced in TEVG investigation, and finally the prospects in TEVG design.

“…As technological innovations continue to be developed, CABG has been increasingly performed in off-pump mode, which not only allows for faster patient recovery but also results in fewer postoperative complications [14]. In addition, many studies have shown that there is no substantial difference between single vein and sequential vein grafts [15][16][17]. Previous studies mainly used NT technology in on-pump CABG, and most of the vein grafts were single vein grafts.…”

Section: Introductionmentioning

confidence: 99%

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

Hou

Zhang

et al. 2021

Preprint

Background In 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 technique (NT) were higher than those obtained by the conventional technique (CON). In the past, NT technology was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analysed the safety and effectiveness of sequential vein grafts using NT technology in off-pump CABG. Methods From 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, postoperative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results There was no significant difference in the patency rate of sequential venous grafts between the two groups one 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). Conclusions The application of the NT technique in off-pump CABG with sequential vein grafts is safe and effective. Leg wound complications are more common with the NT technique than with the conventional technique.