A multicentre, registry-based, randomised trial of the ‘no-touch’ technique for graft harvesting for coronary artery bypass graft (CABG) surgery has shown that the technique is not superior to the conventional method for reducing vein graft failure or improving clinical outcomes.
The no touch technique, which was developed in Sweden, is an atraumatic approach to remove the saphenous vein complete with its cushion of surrounding tissue without touching the vessel at all, unlike traditional vein harvesting where all of the tissue is stripped from the vein.
Stefan James (Uppsala University Hospital, Uppsala, Sweden) presented findings of the SWEDEGRAFT study comparing the two techniques at the European Society of Cardiology (ESC) 2024 Congress (30 August–2 September; London, UK) where he reported that as well as failing to show superiority over the traditional vein harvesting technique, the use of no-touch vein harvesting also raises severe safety concerns.
Several trials have shown improved graft patency using the no-touch technique, James said, and the evidence has led to no-touch vein harvesting holding a IIa B recommendation in 2018 ESC and European Association of Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularisation. Many sites in Europe as well as the USA use this as a standard technique, he said.
SWEDEGRAFT set out to test whether this strategy was superior to conventional grafting in patients aged under 80 years old undergoing first-time isolated non-emergent CABG with at least one saphenous vein graft. Taking place at all eight surgical sites in Sweden and one in Denmark, investigators randomly assigned patients 1:1 to either of the two vein harvesting techniques.
The trial’s primary endpoint was the proportion of patients with graft failure, defined as an occluded or stenosed graft >50% on coronary computed tomography (CT) angiography at least two years after the procedure, clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within two years.
A total of 902 patients were enrolled in the trial, with a mean age of 67 years and 88% were male. James reported that there was no significant difference in the primary endpoint of graft failure within 3.5 years, which occurred in 19.8% of patients in the no-touch group and 24% of patients in the conventional group (p=0.15). There were no significant differences in the three individual components of the primary endpoint.
Regarding secondary endpoints, James reported that the incidence of major adverse cardiovascular events was similar¾12.6% vs. 9.9%¾in the two groups at a mean follow-up of 4.4 years, but there were significantly more leg wound complications among patients randomised to the no-touch technique compared to conventional grafts at three months (24.7% vs. 13.8%) and more negative leg symptoms at 2 years (49.6% vs. 25.2%).
“It [the trial] did not show superiority for vein graft failure or clinical outcomes, but severely increased the risk of leg complications and residual symptoms in these patients, so our trial does not support the current guidelines in using this strategy for bypass surgery,” James said at ESC 2024.
