In a randomized study of 2,655 patients undergoing coronary artery bypass grafting, the no-touch saphenous vein harvesting technique led to better outcomes at 3 years compared with the conventional method.
Patients who received no-touch grafts had significantly lower rates of vein graft occlusion, nonfatal myocardial infarction, repeat revascularization, and angina. At 3 years, the occlusion rate was 5.7% in the no-touch group vs 9.0% in the conventional group (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.48–0.80; P < .001). The absolute risk difference was –3.2 percentage points.
"These results confirm the robustness of the no-touch technique in reducing vein graft occlusion," wrote lead study author Meice Tian, MD, Associate Professor in the Department of Surgery at the National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, and colleagues. Their findings were published in The BMJ.
Researchers enrolled patients across seven cardiac centers into the trial from April 2017 to June 2019. Participants underwent isolated coronary artery bypass grafting (CABG) surgery and were randomly assigned to receive either the no-touch technique, which preserves the vein’s surrounding tissue, or the conventional method, which involves removing the vein’s outer layer and perivascular tissue.
Nonfatal myocardial infarction occurred in 1.2% of patients in the no-touch group compared with 2.7% in the conventional group (hazard ratio [HR] = 0.45; 95% CI = 0.25–0.81; P = .01). Repeat revascularization rates were also lower (1.1% vs 2.2%; HR = 0.51; 95% CI = 0.27–0.95; P = .03). Recurrent angina occurred in 6.2% of the no-touch group and 8.4% of the conventional group (HR = 0.73; 95% CI = 0.55–0.97; P = .03). Hospital readmissions for cardiac causes were reported in 7.1% of no-touch patients vs 10.2% of conventional method patients (HR = 0.68; 95% CI = 0.52–0.89; P = .004).
Computed tomography angiography at 3 years was completed in 86.5% of participants. In the full cohort, occlusion was 6.1% in the no-touch group vs 9.3% in the conventional group (OR = 0.63; 95% CI = 0.51–0.81; P < .001). The benefit of the no-touch technique was consistent across age, sex, comorbidity, and target vessel subgroups.
Mild leg wound symptoms, including swelling and numbness, were more frequent in the no-touch group, but no cases of necrosis or compartment syndrome were reported.
Participants had a mean age of 61 years; 22% were women, and 88% had three-vessel disease. Both patient groups received the same postoperative medical management, including dual antiplatelet therapy and standard secondary prevention.
The no-touch technique maintained the structural integrity of the vein by avoiding manual distension and preserving perivascular tissue, while the conventional technique included removal of the outer vein layers and distension with a storage solution.
No significant differences were observed between groups for stroke or all-cause mortality at 3 years. Investigators noted that longer-term follow-up may be needed to detect differences in those outcomes.
The study’s large sample size, rigorous randomization, and high imaging follow-up rate support the reliability of the findings, noted authors.
Full disclosures are available in the published study.
Source: The BMJ