CABG outcomes improve with no-touch vein harvesting technique
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Among patients undergoing CABG, the no-touch technique for vein harvesting reduced risk for vein graft occlusion and improved patient prognosis compared with the conventional harvesting technique, according to new research in Circulation.
“We found that the occlusion rate in the no-touch treatment group was surprisingly low,” Shengshou Hu, MD, from the Fuwai Hospital in Beijing, said in a press release from the American Heart Association. “The rate was even comparable to grafts from the radial artery and gastroepiploic artery.”
Hu noted that improving the rate at which vein grafts remain open has been a core issue with CABG. “Our goal was to determine if techniques to reduce damage to the veins during harvesting could reduce the incidence of these blockages,” he said.
In the study, Hu, Meice Tian, MD, also of Fuwai Hospital, and colleagues randomly assigned 2,655 patients undergoing CABG to a no-touch technique (n = 1,337) or conventional approach (n = 1,318) for vein harvesting. The procedures occurred from April 2017 to June 2019 at seven hospitals.
For the no-touch group, researchers kept intact adventitia and perivascular tissue of the vein.
Vein graft occlusion on CTA at 3 months served as the primary outcome measure, whereas 12-month vein graft occlusion, recurrence of angina and major adverse cardiac and cerebrovascular events served as secondary outcomes.
Overall, 96% of patients received CTA at 3 months after CABG, whereas 92.2% received it at 12 months.
Results showed that the no-touch technique led to reductions in vein graft occlusion at 3 months compared with the conventional group (2.8% vs. 4.8%; OR = 0.57; 95% CI, 0.41-0.8; P < .001); similar reductions occurred at 12 months (3.7% vs. 6.5%; OR = 0.56; 95% CI, 0.41-0.76; P < .001).
Also at 12 months, a reduction in angina recurrence was observed with the no-touch strategy (2.3% vs. 4.1%; OR = 0.55; 95% CI, 0.35-0.85; P < .01). In the press release, Hu said this outcome “implies the clinical benefit that no-touch brings to our patients by reducing vein graft occlusion and hence, improving their quality of life.”
In other data, there were no significant differences in rates of major adverse cardiac and cerebrovascular events between the two groups, although the no-touch approach yielded higher rates of leg wound surgical interventions at 3 months (10.3% vs. 4.3%; OR = 2.55; 95% CI, 1.85-3.52; P < .001).
“It is still unknown whether the efficacy of the no-touch technique in our patients will be sustained in the long run,” Hu said in the release. “Inspiringly, previous single-center studies from Sweden with limited sample sizes have shown the no-touch technique is maintained as long as 16 years; however, these have no clinical results on the patients. Long-term follow-up of our large-sample patient cohort is necessary and continuing.”
Reference:
- American Heart Association. Outcomes after heart bypass surgery better with ‘no-touch’ technique to remove leg veins. Available at: newsroom.heart.org/news/outcomes-after-heart-bypass-surgery-better-with-no-touch-technique-to-remove-leg-veins. Published Sept. 13, 2021. Accessed Sept. 16, 2021.
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