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Randomized Controlled Trial
. 2025 May 7;46(18):1720-1729.
doi: 10.1093/eurheartj/ehaf018.

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

Stefan Thelin  1   2 , Ivy Susanne Modrau  3   4 , Olov Duvernoy  5 , Magnus Dalén  6   7 , Mats Dreifaldt  8 , Anders Ericsson  9 , Örjan Friberg  8 , Anders Holmgren  10 , Per Hostrup Nielsen  3 , Henrik Hultkvist  11   12 , Karin Jensevik Eriksson  13 , Anders Jeppsson  14   15 , Mats Lidén  16 , Shahab Nozohoor  17   18 , Sigurdur Ragnarsson  17   18 , Ulrik Sartipy  6   7 , Lisa Ternström  14 , Raquel Themudo  19 , Per Vikholm  1   2 , Stefan James  13   20
Affiliations
Randomized Controlled Trial

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

Stefan Thelin et al. Eur Heart J. .

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 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.

Keywords: Coronary artery disease; Long-term outcomes; Mortality; Myocardial infarction; Surgical complications.

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Figures

Structured Graphical Abstract
Structured Graphical Abstract
The SWEDEGRAFT trial design and major results. CI, confidence interval; MACE, major adverse cardiovascular events.
Figure 1
Figure 1
Trial flow chart
Figure 2
Figure 2
Primary outcome in patients randomized to no-touch or conventional vein harvesting
Figure 3
Figure 3
Subgroup analyses for the primary outcome
Figure 4
Figure 4
Leg wound complications at 3 months
Figure 5
Figure 5
Leg wound complications at 2 years
See this image and copyright information in PMC

References

    1. Alexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med 2016;374:1954–64. 10.1056/NEJMra1406944 - DOI - PubMed
    1. Lopes RD, Mehta RH, Hafley GE, Williams JB, Mack MJ, Peterson ED, et al. . Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery. Circulation 2012;125:749–56. 10.1161/CIRCULATIONAHA.111.040311 - DOI - PMC - PubMed
    1. Hess CN, Lopes RD, Gibson CM, Hager R, Wojdyla DM, Englum BR, et al. . Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation 2014;130:1445–51. 10.1161/CIRCULATIONAHA.113.008193 - DOI - PMC - PubMed
    1. Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. . Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004;44:2149–56. 10.1016/j.jacc.2004.08.064 - DOI - PubMed
    1. de Vries MR, Simons KH, Jukema JW, Braun J, Quax PH. Vein graft failure: from pathophysiology to clinical outcomes. Nat Rev Cardiol 2016;13:451–70. 10.1038/nrcardio.2016.76 - DOI - PubMed

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