Journal Article

SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)

Deb, Saswata, Fremes, Stephen E., Meyer, Steven R., Tam, Derrick Y., Chu, Michael W. A., Singh, Steve K., de Souza, Domingos, Al-Saleh, Ayman, Rao-Melacini, Purnima, Belley-Cote, Emilie P., Brady, Katheryn, Devereaux, P. J., Novick, Richard J., Whitlock, Richard, Verma, Subodh, Jeppsson, Anders

2019

Overview

Background Single centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG). Methods Adults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results. Results Two hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p  = 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%), p  = 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%, p  < 0.01). Including this study’s results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29–0.82, p  = 0.007 in 3 randomized and 1 observational study at 1 year postoperatively. Conclusions The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting. Trial registration NCT01047449 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Angiography / atherosclerosis / Bypass / bypass grafting surgery / Cardiac Surgery / Cardiology and Cardiovascular Disease / CAT scans / cerebrovascular outcomes / Confidence intervals / Conventional open / Conventional open saphenous vein graft harvesting / Coronary artery / Coronary artery bypass / Coronary Artery Bypass - methods / Coronary artery bypass grafting surgery / Coronary vessels / Diagnostic imaging / Endoscopic saphenous vein graft / Endoscopic saphenous vein graft harvesting / Female / Graft patency / Grafting / Harvesting / Health aspects / Heart attacks / Heart surgery / Humans / internal-thoracic-artery / Kardiologi och kardiovaskulära sjukdomar / Major adverse cardiac and / Major adverse cardiac and cerebrovascular outcomes / Male / Medical research / Medicine / Medicine & Public Health / Methods / Multi-centred randomized controlled trial / No touch atraumatic saphenous vein graft harvesting / Occlusion / Organ removal / pedicled vein grafts / Physiological aspects / progression / Randomization / Reduction / Research Article / Road construction industry / Saphenous Vein - transplantation / saphenous vein graft harvesting / Statistical analysis / Stenosis / Surgeons / surgery / surrounding tissue / Systematic review / Thoracic Surgery / Tissue and Organ Harvesting - methods / Variables / Vascular Patency / Veins & arteries