A new large multicenter study from China has suggested that using a modified surgical technique to harvest vein grafts for coronary artery bypass surgery (CABG) resulted in fewer graft blockages and recurrence of cardiac chest pain.^1,2

The study included 2655 adults, who underwent CABG at seven cardiac surgery centers in China. Two vein harvesting techniques - conventional and “no-touch” - were compared to analyse the differences between them in occurrence of post-surgery vein blockage or chest pain.

“In the no-touch group, adventitia and perivascular tissue of the vein were carefully kept intact. Forced manual distension with a syringe was not permitted. In the conventional group, the vein’s adventitia was stripped off by blunt dissection with a scissor, and the vein was gently distended by a syringe with the storing solution.”

The conventional-harvesting group included 1313 patients, while 1325 patients had their vein graft harvested via the no-touch technique A CT scan was done at 3 months and 12 months of follow up. A 3-year follow-up of the study participants is ongoing.

Results of the study published in the journal Circulation show that at 3 months of follow up, nearly 50% decline in graft occlusion rate with the no-touch technique was noted. Grafts obtained via the conventional-harvesting technique were less patent as evident on CT scan compared to the grafts obtained using the no-touch technique; 4.8% versus 2.8%, respectively.

About 3.7% of the grafts were blocked in the no-touch group vis-à-vis 6.5% of the grafts in the conventional-harvesting group at one year after the surgery. More patients in the conventional harvesting group (4.1%) reported recurrence of anginal pain than in the no-touch group (2.3%). No between-group differences were observed in the incidence of major adverse cardiovascular events including cardiovascular death or the need for repeat revascularization. The incidence of wound complications (such as infection) was higher in the no-touch group 10.3% versus 4.3% in the conventional-harvesting group. However, the authors are of the view that control of risk factors and providing dedicated training to surgeons can minimise such complications.

This study has shown that adoption of the newer no-touch technique in harvesting vein grafts for CABG yielded more patent grafts and successful outcomes, although no survival benefit was observed. By reducing the chances of vein graft blockage, the no-touch technique enhances the quality of life of the patient. Dedicated training can reduce the learning curve for the surgeon resulting in more consistent benefits of the no-touch technique.

References

1. Tian M, et al. No-touch versus conventional vein harvesting techniques at 12 months after coronary artery bypass grafting surgery: multicenter randomized, controlled trial. Circulation. 2021 Sep 13. doi: 10.1161/CIRCULATIONAHA.121.055525.
2. American Heart Association News Release, September 13, 2021.