Surgical Aspects of No-Touch Saphenous Vein Graft Harvesting in CABG: Clinical and Angiographic Follow-Up at 3 Months

Samano, Ninos; Pinheiro, Bruno Botelho; Souza, Domingos

doi:10.21470/1678-9741-2018-0352

Cited by 6 publications

(6 citation statements)

References 4 publications

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“…Several studies 11,13,14,16,[22][23][24][25] have shown the superiority of NT SVGs compared to C SVGs on follow-up at a mean time up to 16 years 14 . Previous studies have, however, had either a limited follow-up time of maximum 1 year 22,23,25 or included a limited number of patients (fewer than 300) 11,13,14,16,23,24 .…”

Section: Discussionmentioning

confidence: 99%

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients

Ferrari,

Loayza,

Azari

et al. 2024

Preprint

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ObjectivesTo evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique.MethodsThis was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel).ResultsThe study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR= 1.8).ConclusionsThe no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts.Clinical Trial RegistrationNCT04656366, 7 December 2020Clinical Perspective-What is new?➣The largest follow-up of the patency of no-touch vein grafts in the international literature.➣Patients with a no-touch vein graft had significantly better patency (p < 0.001) at mean follow-up of more than 8 years.-What are the clinical implications?➣Consequent reduction in cardiovascular events after no-touch vein graft.➣Benefits at individual level due to fewer episodes of re-angina and myocardial infarction, and fewer coronary interventions.➣Benefits at community level due to fewer re-hospitalizations and a reduction in healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients

Ferrari,

Loayza,

Azari

et al. 2024

Preprint

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“…Over two decades ago, the 'no-touch' (NT) technique of harvesting SV was introduced [13] . Using an atraumatic method, the vein is removed with a pedicle of surrounding tissue and with minimal vascular damage [14] . Subsequently, a randomized trial comparing C SVG and NT SVG has shown that the latter is superior in terms of patency rates and left ventricular ejection fraction at 1.5, 8.5, and 16 years postoperatively [15][16][17][18] , as seen in Table 1 from Samano et al [17] , 2015.…”

Section: Saphenous Vein Structure and Vascular Damagementioning

confidence: 99%

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Samano¹,

Souza²,

Pinheiro³

et al. 2020

Braz J Cardiovasc Surg

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The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.

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“…Avoiding direct contact with the vessel prevents spasm and the need for manual distension. 25 Side-branches are ligated and divided at the same distance from the SV. After removal, the SV is stored in heparinized blood.…”

Section: No-touch Saphenous Vein Graft Harvestingmentioning

confidence: 99%

“…Hence, there is no need for distension and endothelial damage is minimized. 25 , 26 , 37 – 39 An additional beneficial effect of preserved outer layers of the SV is the protection conferred on the luminal endothelium once inserted as a graft and subjected to arterial hemodynamics. A study comparing sections of CT versus NT harvested SVs showed marked differences in endothelial integrity.…”

Section: Comparison Of Synthetic and Natural External Stents; Mechanical Propertiesmentioning

confidence: 99%

Saphenous veins in coronary artery bypass grafting need external support

Samano

Souza

Dashwood

2020

Asian Cardiovasc Thorac Ann

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The saphenous vein is the most commonly used conduit for coronary artery bypass grafting. Arterial grafts are harvested with the outer pedicle intact whereas saphenous veins are harvested with the pedicle removed in the conventional graft harvesting technique. This conventional procedure causes considerable vascular damage. One strategy to improve vein graft patency has been to provide external support. Ongoing studies show that fitting a metal external support improves conventionally harvested saphenous vein graft patency. On the other hand, the no-touch technique of harvesting the saphenous vein provides an improved graft with long-term patency comparable to that of the internal mammary artery. This improvement is suggested to be due to preservation of vessel structures. Interestingly, many of the mechanisms proposed to be associated with the beneficial actions of an artificial external support on saphenous vein graft patency are similar to those underlying the beneficial effect of no-touch saphenous vein grafts where the intact outer layer acts as a natural support. Additional actions of external supports have been advocated, including promotion of angiogenesis, increased production of vascular-protective factors, and protection of endothelial cells. Using no-touch harvesting, normal vascular architecture is maintained, tissue and cell damage is minimized, and factors beneficial for graft patency are preserved. In this review, the significance of external support of saphenous vein grafts in coronary artery bypass grafting is discussed.

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Surgical Aspects of No-Touch Saphenous Vein Graft Harvesting in CABG: Clinical and Angiographic Follow-Up at 3 Months

Cited by 6 publications

References 4 publications

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Saphenous veins in coronary artery bypass grafting need external support

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