Original article
Adult cardiac
No-Touch Saphenous Vein Harvesting May Improve Further the Patency of Saphenous Vein Composite Grafts: Early Outcomes and 1-Year Angiographic Results

https://doi.org/10.1016/j.athoracsur.2016.09.024Get rights and content

Background

Harvesting technique and surgical strategy may affect patency rates of saphenous vein (SV) grafts in coronary artery bypass graft surgery (CABG). We evaluated early clinical outcomes and 1-year graft patency rates of SV grafts that were harvested with a no-touch technique and used as composite grafts.

Methods

Three hundred sixty-eight patients who underwent off-pump CABG using SV composite grafts based on the left internal thoracic artery were studied. The results of 103 patients who received SV grafts harvested with a “no-touch” technique (group NT) were compared with the results of 265 patients who received SV grafts harvested with a “minimal manipulation” technique (group MM). A propensity score-matched analysis was also performed to minimize differences in preoperative and intraoperative variables (n = 98 in each group). Early clinical outcomes and early and 1-year postoperative angiographic results were compared.

Results

No differences in early mortality or postoperative complications were observed between the two groups. Early postoperative (1.6 ± 2.2 days) angiography demonstrated a significantly higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 100% versus 97.2%, p = 0.002; after, 100% versus 97.7%, p = 0.003). One-year postoperative (13.0 ± 2.5 months) angiography also showed a higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 97.4% versus 92.4%, p = 0.024; after, 97.3% versus 92.6%, p = 0.051).

Conclusions

The SV grafts harvested with a no-touch technique further improved the early and 1-year patency of SV composite grafts. Midterm and long-term angiographic follow-up may be warranted to demonstrate the superiority of no-touch SV composite grafts.

Section snippets

Material and Methods

The study protocol was reviewed by the Institutional Review Board and approved as a minimal risk retrospective study (approval number: H-1601-064-734) that did not require individual consent based on the institutional guidelines for waiving consent.

Clinical Outcomes

Operative mortality was 1.0% (1 of 103) in group NT and 0.4% (1 of 265) in group MM (p = 0.487). There were no statistically significant differences in operative mortality and postoperative complications between the two groups before and after propensity score matching (Table 3). Leg wound complications in the SV harvesting site developed in 5 patients (group NT, 2.9% [3 of 103] versus group MM, 0.8% [2 of 265], p = 0.136). Of 366 surviving patients, a Jackson-Pratt drain was inserted in the SV

Comment

The present study demonstrated three main findings. First, the 1-year patency rate of SV grafts harvested with a “no-touch” technique further improved the early and 1-year patency of SV composite grafts. Second, the majority of the “no-touch” SV grafts that demonstrated a competitive flow in the early postoperative angiograms were patent at 1 year postoperatively. Third, leg wound complications in the SV harvesting site were not more common among patients who received SV grafts harvested using

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