Hot Line: No advantage of ‘no-touch’ vein harvesting over conventional technique for CABG
01 Sep 2024
Trials have suggested that using a ‘no-touch’ technique to harvest the saphenous vein graft during coronary artery bypass grafting (CABG), where the vein is harvested with part of the surrounding tissue, may reduce graft failure compared with the conventional open technique where the vein is stripped of surrounding tissue.1,2 The SWEDEGRAFT trial compared no-touch and conventional harvesting in terms of short-term graft failure and long-term outcomes.
In this registry-based trial conducted in Sweden and Denmark, patients under 80 years old who were scheduled for first-time isolated non-emergent CABG with at least one saphenous vein graft were randomised to vein graft harvest using the no-touch technique or the conventional technique.
The primary endpoint was the proportion of patients with graft failure defined as: graft occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, patient had undergone PCI in a vein graft or in a native vessel segment proximal to the distal anastomosis of a vein graft, or death within 2 years.
In total, 902 participants were randomised who had a mean age of 67 years, with 88% male. The mean EuroSCORE II score was 1.6. In 53% of cases, CABG was performed as an elective procedure.
There was no significant difference in graft failure within 2 years, which occurred in 19.8% of patients in the no-touch group and 24.0% in the conventional group (difference −4.3%; 95% CI −10.1 to 1.6; p=0.15).
The incidence of major adverse cardiovascular events (all-cause death, myocardial infarction or any repeat revascularisation during follow-up) was similar in the no-touch and conventional groups at mean follow-up of 52 months (12.6% vs. 9.9%; hazard ratio 1.30; 95% CI 0.87 to 1.93; p=0.195). However, there were significantly more leg wound complications with no-touch vs. conventional grafts at 3 months (24.7% vs. 13.8%; difference 10.9%; 95% CI 5.7 to 16.1) and at 2 years (49.6% vs. 25.2%; difference 24.4%; 95% CI 17.7 to 31.1).
Trial presenter, Professor Stefan James (Uppsala University - Uppsala, Sweden) concluded: “We have shown that the no-touch technique was not superior to the conventional technique in reducing graft failure or improving clinical events after CABG and was associated with more early and late leg wound complications. There was surprisingly good longevity of conventional vein grafts, reflecting the high quality of surgical and medical standards in Scandinavia. Our study highlights the importance of independent research where dedicated clinicians collaborate in large all-comer randomised controlled trials to determine the best treatment for the benefit of our patients. Results from this pragmatic registry trial, designed to reflect routine clinical practice, do not support the routine use of no-touch harvesting and our findings should be considered in future guidelines.”
References
- Sousa DSR, et al. Ann Thorac Surg. 2002;73:1189–1195.
- Tian M, et al. Circulation. 2021;144:1120–1129.
