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No-touch vein grafts in coronary artery bypass surgery : a registry-based randomized clinical trial

Thelin, Stefan ; Modrau, Ivy Susanne ; Duvernoy, Olov ; Daln, Magnus ; Dreifaldt, Mats ; Ericsson, Anders ; Friberg, Örjan ; Holmgren, Anders ; Hostrup Nielsen, Per and Hultkvist, Henrik , et al. (2025) In European Heart Journal 46(18). p.1720-1729
Abstract

Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred... (More)

Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Coronary artery disease, Long-term outcomes, Mortality, Myocardial infarction, Surgical complications
in
European Heart Journal
volume
46
issue
18
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:105004749799
  • pmid:39969129
ISSN
0195-668X
DOI
10.1093/eurheartj/ehaf018
language
English
LU publication?
yes
id
d902a78d-e90b-4feb-95fc-7c3918ff2c85
date added to LUP
2025-08-01 10:54:43
date last changed
2025-08-15 12:07:48
@article{d902a78d-e90b-4feb-95fc-7c3918ff2c85,
  abstract     = {{<p>Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed &gt;50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.</p>}},
  author       = {{Thelin, Stefan and Modrau, Ivy Susanne and Duvernoy, Olov and Daln, Magnus and Dreifaldt, Mats and Ericsson, Anders and Friberg, Örjan and Holmgren, Anders and Hostrup Nielsen, Per and Hultkvist, Henrik and Jensevik Eriksson, Karin and Jeppsson, Anders and Lidn, Mats and Nozohoor, Shahab and Ragnarsson, Sigurdur and Sartipy, Ulrik and Ternström, Lisa and Themudo, Raquel and Vikholm, Per and James, Stefan}},
  issn         = {{0195-668X}},
  keywords     = {{Coronary artery disease; Long-term outcomes; Mortality; Myocardial infarction; Surgical complications}},
  language     = {{eng}},
  number       = {{18}},
  pages        = {{1720--1729}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{No-touch vein grafts in coronary artery bypass surgery : a registry-based randomized clinical trial}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehaf018}},
  doi          = {{10.1093/eurheartj/ehaf018}},
  volume       = {{46}},
  year         = {{2025}},
}