No-Touch Vein Harvesting Reduces Graft Failure Risk for Heart Bypass Patients

A coronary artery bypass graft (CABG) is a surgical procedure used to enhance blood flow and oxygen supply to the heart in individuals with coronary heart disease. During the procedure, a healthy blood vessel, often taken from the saphenous vein in the lower leg, is grafted onto the coronary artery. The traditional method of vein harvesting involves stripping the vein of its surrounding tissue before grafting it, a technique that is associated with high rates of graft occlusion, where the vein becomes blocked or narrowed, restricting blood flow. In contrast, the no-touch method involves harvesting the vein while preserving a cushion of surrounding tissue. Now, a study published in The BMJ has shown that the no-touch vein harvesting technique significantly reduces the risk of graft failure up to three years after coronary artery bypass surgery compared to the conventional vein harvesting approach.

The no-touch technique had already demonstrated significantly lower occlusion rates at 3 and 12 months post-surgery in the PATENCY trial. However, the long-term effects of this technique were still unclear. To address this knowledge gap, researchers at China Medical University’s Shengjing Hospital (Liaoning, China) conducted a three-year follow-up of the PATENCY trial to evaluate the long-term outcomes of the no-touch technique compared to the conventional method. The study involved 2,655 patients (average age 61; 22% women) who were undergoing CABG at seven cardiac surgery centers in China. The patients were randomly assigned to either the no-touch vein harvesting group (1,337 patients) or the conventional technique group (1,318 patients). After three years, the no-touch group exhibited a significantly lower vein graft occlusion rate than the conventional group (5.7% versus 9%).

In addition to the lower occlusion rates, several other outcomes were notably improved in the no-touch group. The rates of non-fatal heart attack, repeat revascularization, recurrent angina, and hospital readmissions for cardiac reasons were significantly lower in the no-touch group (1.2% vs 2.7%, 1.1% vs 2.2%, 6.2% vs 8.4%, and 7.1% vs 10.2%, respectively), further supporting the clinical benefits of the no-touch technique. However, there were no significant differences in causes of death or in major adverse cardiac and cerebrovascular events. The researchers acknowledge several limitations, noting that these findings might reflect random variation rather than a definitive biological effect. Additionally, the study primarily involved relatively young individuals in China, so the results may not be applicable to other age groups or nationalities. Nonetheless, the researchers highlight that the results remained consistent after additional analyses and believe these findings could have important implications for clinical practice and the development of guidelines.

“This study provides robust evidence supporting the use of the no-touch technique to reduce the risk of vein graft occlusion, a critical factor in the long-term success of CABG surgery. The decreased rates of vein graft occlusion observed in the no-touch group translate into meaningful clinical benefits, as demonstrated by the lower incidences of non-fatal myocardial infarction and repeat revascularization,” concluded the researchers.