Dr. Murat Yiğitbaşı

Name of the Study: No-touch vein grafts in coronary artery bypass grafting (SWEDEHEART)

Published in Congress: ESC Congress 2024

Link: Full Text has not been published yet

https://www.tctmd.com/news/no-go-no-touch-svg-harvesting-cabg-surgery-swedegraft

Background

Previous 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 surrounding tissue, may reduce graft failure compared to the conventional open technique, where the vein is stripped of surrounding tissue.

Objective

This trial aimed to compare the no-touch and conventional harvesting techniques regarding short-term graft failure and long-term clinical outcomes.

Methods

This registry-based, randomized trial was conducted in Sweden and Denmark, including patients under 80 years old scheduled for first-time isolated non-emergent CABG with at least one saphenous vein graft. Participants were randomly assigned to undergo vein graft harvest using either the no-touch technique or the conventional technique. The primary endpoint was graft failure within 2 years, defined as graft occlusion or stenosis >50% on coronary computed tomography angiography, the need for percutaneous coronary intervention (PCI) in a vein graft or in a native vessel segment proximal to the distal anastomosis of a vein graft, or death. The other endpoints included major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, or any repeat revascularization.

Results

A total of 902 participants were randomized, with a mean age of 67 years, and 88% were male. The mean EuroSCORE II was 1.6, and CABG was performed electively in 53% of cases. There was no significant difference in graft failure between the no-touch and conventional groups at 2 years (19.8% vs. 24.0%, difference -4.3%; 95% CI -10.1 to 1.6; p=0.15). The incidence of MACE at a mean follow-up of 52 months was similar between groups (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 in the no-touch group compared to the conventional group 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).

Conclusion

The SWEDEGRAFT trial found that the no-touch technique was not superior to the conventional technique in reducing graft failure or improving clinical outcomes after CABG. Additionally, the no-touch technique was associated with a higher rate of early and late leg wound complications. These findings suggest that routine use of the no-touch harvesting technique is not supported, and the results should be considered in future clinical guidelines.

Interpretation

The SWEDEGRAFT trial demonstrated that the no-touch technique for saphenous vein graft harvesting during CABG did not reduce graft failure or improve clinical outcomes compared to the conventional technique. However, the no-touch method was associated with significantly more leg wound complications both early and late after surgery. These findings suggest that the no-touch technique does not offer the expected benefits in terms of graft patency or clinical outcomes and poses additional risks for wound complications.