Photo Credit: Vital Hil
A no-touch vein harvesting strategy was not superior to conventional surgery in patients undergoing non-emergent coronary artery bypass grafting (CABG). However, the investigational technique was associated with an increased rate of leg wound complications.
The SWEDEGRAFT trial (NCT03501303) hypothesized that no-touch vein grafts outperform conventionally harvested veins regarding graft patency and long-term clinical outcomes. To test this hypothesis, Stefan James, MD, Uppsala University, Sweden, and colleagues randomly assigned 900 participants undergoing non-emergent CABG 1:1 to the no-touch saphenous vein graft (SVG) arm or the conventional SVG arm. The primary endpoint was graft failure within 2 years after CABG, defined as at least 1 SVGs occluded/stenosed >50% on computed tomography angiography, or PCI in a vein graft or adjacent native vessel, or death.
Although the primary endpoint was numerically in favor of the ‘no-touch’ arm after a mean duration of 3.5 years following randomization, the observed difference in primary outcome events did not reach statistical significance (19.8% vs 24.0%; 95% CI -10.1 to 1.6; P=0.15). Prof. James added that the investigators did see a remarkable significant interaction effect: participants in the no-touch arm without diabetes had a lower event rate (OR 0.61; 95% CI 0.40–0.92), whereas participants in the no-touch arm with diabetes had an increased event rate (OR 2.05; 95% CI 1.08–3.88; P=0.002). There was no significant difference between the no-vein and conventional arms with respect to MACE (12.6% vs 9.9%; HR 1.30; 95% CI 0.87–1.93; P=0.20). However, leg wound complications at 3 months were significantly more common in the no-touch arm (24.7% vs 13.8%) as was the rate of participants who still had leg wound symptoms at 2 years of follow-up (49.6% vs 25.2%).
“Our trial does not support the routine use of the no-touch harvesting technique compared with the standard technique of vein handling for patients undergoing non-emergent CABG,” concluded Prof. James.
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