Slower progression of atherosclerosis in vein grafts harvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study

Johansson, Benny; Souza, Domingos; Bodin, Lennart; Filbey, Derek; Loesch, Andrzej; Geijer, Håkan; Bojö, Leif

doi:10.1016/j.ejcts.2010.02.007

Cited by 75 publications

(58 citation statements)

References 21 publications

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“…Given that saphenous vein is an autologous transplanted organ, harvest and preparation manipulations should be designed to minimize injury, which may lead to reduced intimal hyperplasia and improved clinical outcomes. 6,7 …”

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confidence: 99%

Brilliant Blue FCF as an Alternative Dye for Saphenous Vein Graft Marking

et al. 2014

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IMPORTANCE Surgical skin markers are used off-label to mark human saphenous veins (HSVs) to maintain orientation before implantation as aortocoronary or peripheral arterial bypass grafts. These surgical skin markers impair functional responses of the HSV tissue. OBJECTIVES To investigate the effect of brilliant blue dye 1 (brilliant blue FCF [for food coloring]; hereinafter, FCF) as a nontoxic alternative marking dye and to determine whether FCF has pharmacological properties. DESIGN, SETTING, AND PARTICIPANTS Segments of HSVs were collected in university hospitals from patients undergoing coronary artery bypass grafting procedures immediately after harvest (unmanipulated) or after typical intraoperative surgical graft preparation (after manipulation). Rat inferior venae cavae were used to determine the pharmacological properties and cellular targets of FCF. Endothelial and smooth muscle functional responses were determined in a muscle bath, and intimal thickening in HSVs was determined after 14 days in organ culture. MAIN OUTCOMES AND MEASURES Contractile responses were measured in force and converted to stress. Smooth muscle function was expressed as maximal responses to potassium chloride depolarization contractions. Endothelial function was defined as the percentage of relaxation of maximal agonist-induced contraction. Neointimal thickness was measured by histomorphometric analysis. RESULTS Human saphenous veins stored in the presence of FCF had no loss of endothelial or smooth muscle function. Unmanipulated HSVs preserved in the presence of FCF demonstrated a significant increase in endothelial-dependent relaxation (mean [SEM], 25.2% [6.4%] vs 30.2% [6.7%]; P = .02). Application of FCF to functionally nonviable tissue significantly enhanced the smooth muscle responses (mean [SEM], 0.018 [0.004] × 105N/m2 vs 0.057 [0.016] × 105 N/m2; P = .05). Treatment with FCF reduced intimal thickness in organ culture (mean [SEM], −17.5% [2.1%] for unmanipulated HSVs vs −27.9% [3.7%] for HSVs after manipulation; P < .001). In rat inferior venae cavae, FCF inhibited the contraction induced by the P2X7 receptor agonist 2′(3′)-O-(4-benzoyl)benzoyl-adenosine-5′-triphosphate (mean [SEM], 14.8% [2.2%] vs 6.5% [1.8%]; P = .02) to an extent similar to the P2X7 receptor antagonist oxidized adenosine triphosphate (mean [SEM], 5.0% [0.9%]; P < .02 vs control) or the pannexin hemichannel inhibitor probenecid (mean [SEM], 7.3% [1.6%] and 4.7% [0.9%] for 0.5mM and 2mM, respectively; P < .05). CONCLUSIONS AND RELEVANCE Treatment with FCF did not impair endothelial or smooth muscle function in HSVs. Brilliant blue FCF enhanced endothelial-dependent relaxation, restored smooth muscle function, and prevented intimal hyperplasia in HSVs in organ culture. These pharmacological properties of FCF may be due to P2X7 receptor or pannexin channel inhibition. Brilliant blue FCF is an alternative, nontoxic marking dye that may improve HSV conduit function and decrease intimal hyperplasia.

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confidence: 99%

Brilliant Blue FCF as an Alternative Dye for Saphenous Vein Graft Marking

et al. 2014

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“…Johansson et al [2] conducted a randomised-controlled trial of 104 patients with SV grafts harvested by the conventional technique (CT) and the no-touch technique (NT), analysing graft patency rates with focus on early atherosclerotic changes. In the short-term study (18 months) stenosis was observed in 11.0% of grafts in the NT-group versus 25.0% in the CT-group (P=0.006).…”

Section: Resultsmentioning

confidence: 99%

Does a 'no-touch' technique result in better vein patency?

Sepehripour

Jarral

Shipolini

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. A total of 405 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the ultrastructural and mechanical properties of the endothelium and vessel walls of the two harvesting techniques; the protein and enzymatic expression and activity observed; the early atherosclerotic changes detected; and the overall patency of the grafts during short- and long-term angiographical follow-up. Three small prospectively randomised studies compared the patency of grafts harvested using the two techniques and found significant improvements in graft patency using the no-touch harvesting technique in comparison to both the conventional technique and more importantly comparable to the left internal thoracic artery (LITA) patency. The most favourable difference was that of graft patency after 8.5 years of follow-up [90% vs. 76% (P = 0.01), LITA patency 90%], and incidence of graft stenosis [11% vs. 25% (P = 0.006)]. These findings were supported by the demonstrated improvements in the cellular integrity of the vessels and the reduction in the mechanisms leading to graft failure seen in the no-touch harvested SV grafts. These morphological and cellular analyses were carried by five small comparative studies, demonstrating improved endothelial integrity and reduced injury, decelerated atherosclerotic processes, intact adventitial collagen layers, increase in the total area of vasa vasorum, elevated endothelial nitric oxide synthase expression and activity, and increased peri-vascular leptin levels and activity. We conclude that there are clear enhancements in vessel wall properties at a cellular level and angiographical evidence of superior graft patency when the no-touch SV harvesting technique is employed.

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“…Johansson et al conducted a randomized controlled trial of 104 patients with LSV grafts harvested by either a COT or NT technique. The primary outcome measures were graft patency rates, intimal thickness and degree of intimal hyperplasia at 18 months (short‐term) and 8.5 years (long‐term) postoperatively, with a focus on cineangiographic‐evaluated stenosis.…”

Section: The No‐touch Techniquementioning

confidence: 99%

Long saphenous vein harvesting techniques and their effect on graft patency

et al. 2019

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Coronary artery bypass grafting is a key cardiac surgery procedure and is the main treatment for patients with multivessel coronary artery disease. The most frequently used conduit for this procedure is the long saphenous vein (LSV). The technique of harvesting the LSV has evolved over the last 30 years from total open harvesting to endoscopic with minimal access technique. The most important determining factor for success in coronary artery surgery is the graft patency rate. The literature evidence behind each technique has been reported at different levels and there is an ongoing debate about which technique can provide optimum vein patency over the long term. This literature review aims to summarize the current evidence, the implications involved with the use of each technique for harvesting LSV and the patency rate at variable follow‐up intervals.

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Slower progression of atherosclerosis in vein grafts harvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study

Abstract: The superior long-term patency rate using the NT vein-graft technique at CABG could be explained by a significantly slower progression of atherosclerosis.

Cited by 75 publications

References 21 publications

Brilliant Blue FCF as an Alternative Dye for Saphenous Vein Graft Marking

Brilliant Blue FCF as an Alternative Dye for Saphenous Vein Graft Marking

Does a 'no-touch' technique result in better vein patency?

Long saphenous vein harvesting techniques and their effect on graft patency

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