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No touch vein harvesting technique for coronary artery by-pass surgery: impact on patency rate, development of atheroscleosis, left ventricular function and clinical outcome during 16 years follow-up
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis was based on a prospective randomized trial which was started in 1993 to compare the no touch (NT) with the conventional (C) technique of saphenous vein harvesting for CABG.

In paper I, was demonstrated superior patency for the NT grafts at short-term (1.5 years; 95,6% vs 89%; p < 0,05) and long-term follow-up (8.5 years; 90% vs 76%; p = 0,01).

In paper II, at long-term follow-up there were significantly more patients free from recurrent angina and in NYHA-class I in the NT group (67,3% vs 43,2%; p = 0,02). In addition there was no cardiac death and a trend towards improvement of hard clinical endpoints in the NT group.

In paper III, we tested the hypothesis that the NT harvesting technique could provide a reduced progression of the atherosclerotic disease in the vein graft wall by using cineangiography and an intravascular ultrasound (IVUS) assessment. At short-term follow- up, the cineangiogram showed more normal grafts in the NT group (89% vs 75%; p = 0,006). The IVUS assessment showed less mean intimal thickness (0.43 (0.07) mm vs 0.52 (0.08) mm; p = 0.03), less grafts with considerable intimal hyperplasia (>0.9 mm; 20% vs 78.6%; p = 0.011) and fewer patients with grafts containing considerable hyperplasia (>0.9 mm; 25% vs 100%; p = 0.007) for the NT vein grafts. At long-term follow-up the cineangiogram showed more normal grafts, 91.2% in the NT group compared with 83.1% in the C group; there were fewer grafts with significant stenosis, with 7.7% in the NT group compared with 15.6% in the C group. The IVUS assessment showed fewer grafts containing multiple plaques (14.8% vs 50%; p = 0.008), less advanced plaque with lipid (11.8% vs 63.9%; p = 0.0004) and less maximal plaque thickness (1.04 (0.23) mm vs 1.32 (0.25) mm; p = 0.02) in the NT vein grafts.

In paper IV, was demonstrated a preserved left ventricular ejection fraction in the NT group compared with the C group (57,9 + 9,5% vs 49,4 + 13,3%; p = 0.004) at 16 years follow-up. Also, a smaller left atrium size, a lower BNP value and fewer patients with atrial fibrillation in the NT group indicated a better left ventricular diastolic function. In conclusion: This thesis showed that the no-touch vein harvesting technique provided a superior long-term patency compared with the conventional technique due to a delayed atherosclerotic process in vein grafts. This was associated with a preserved left ventricular systolic function at 16 years follow-up period.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2013. , p. 47
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 87
Keywords [en]
atherosclerosis, coronary artery disease, coronary artery bypass grafting, vein grafts, no touch vein harvesting technique, intravascular ultrasound, echocardiography, clinical outcome, revascularization, outcome analysis, angina pectoris, myocardial infarction, mortality, randomized trial
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-28426ISBN: 978-91-7668-928-8 (print)OAI: oai:DiVA.org:oru-28426DiVA, id: diva2:611681
Public defence
2013-05-31, Wilandersalen, Universitetssjukhuset i Örebro, Örebro, 13:00 (Swedish)
Opponent
Available from: 2013-03-18 Created: 2013-03-18 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial
Open this publication in new window or tab >>Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial
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2006 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 132, no 2, p. 373-U75Article in journal (Refereed) Published
Abstract [en]

Objective: Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure. A novel "no touch" technique provides high short- and long-term patency rates.

Method: This randomized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery. Conventional: 52 patients had their veins stripped, distended, and stored in saline solution. No-touch: 52 patients had veins removed with surrounding tissue, not distended, and stored in heparinized blood. Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups.

Results: The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups. The angiographic assessment at 18 months postoperatively showed 89% conventional versus 95% no-touch grafts were patent. Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76% and 90% for the no- touch group ( P =.01). The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting ( odds ratio = 3.7, P =.007) for the no- touch versus the conventional technique and the vein quality before implantation ( odds ratio = 3.2, P =.007) for veins that were of good quality. By comparison the patency of the thoracic artery grafts was 90%.

Conclusion: Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-30103 (URN)10.1016/j.jtcvs.2006.04.002 (DOI)000239549700031 ()
Available from: 2013-08-01 Created: 2013-08-01 Last updated: 2018-02-05Bibliographically approved
2. No touch vein harvesting technique for CABG improves the long-term clinical outcome
Open this publication in new window or tab >>No touch vein harvesting technique for CABG improves the long-term clinical outcome
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2009 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 1, p. 63-68Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the long-term clinical outcome, averaging 8.5 years, of two saphenous vein harvesting techniques for CABG; no touch (NT) versus conventional (C). DESIGN: In a randomized study, 49/52 in group NT and 44/52 in group conventional were evaluated for reangina, myocardial infarction, new revascularization, functional class, risk factors and medical treatment. The vein grafts and the native coronary arteries were correlated to the occurrence of reangina. RESULTS: There were significantly more patients free from angina and in NYHA class I (67.3 versus 43.2%; p =0.02) in group NT compared to group C. No cardiac death was found in group NT versus three in group C. There were trends towards fewer patients with cardiac death or myocardial infarction (3.8 vs. 13.4%; p =0.16), more patients free from angina (75.5 vs. 63.6%; p =0.26) and fewer patients with graft occlusion (24.3 vs. 43.2% (p =0.14) in group NT. CONCLUSIONS: The results of the NT-technique are encouraging with no cardiac deaths, significantly more asymptomatic patients and a trend towards impact on hard clinical endpoints compared to the conventional technique.

Place, publisher, year, edition, pages
Stockholm: Scandinavian University Press, 2009
National Category
Medical and Health Sciences Surgery Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-6938 (URN)10.1080/14017430802140104 (DOI)18609044 (PubMedID)
Available from: 2009-05-26 Created: 2009-05-26 Last updated: 2017-12-13Bibliographically approved
3. Slower progression of atherosclerosis in vein grafts harvested with 'no touch' technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study
Open this publication in new window or tab >>Slower progression of atherosclerosis in vein grafts harvested with 'no touch' technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study
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2010 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 38, no 4, p. 414-419Article in journal (Refereed) Published
Abstract [en]

Objectives: In a long-term randomised coronary artery bypass grafting (CABG) study, the patency rate using a new 'no touch' (NT) vein-graft preparation technique was superior to the conventional (C) technique. This cineangiographic and intravascular ultrasound (IVUS) substudy examined possible mechanisms.

Methods: A total of 45 patients (118 grafts) in the NT group and 46 patients (112 grafts) in the C group had patent grafts at short-term follow-up after 18 months. Thirty-seven patients (91 grafts) in the NT group and 37 patients (77 grafts) in the C group had patent grafts at long-term follow-up after 8 5 years, and were evaluated on a scale from 0 (normal) to 2 (significant stenosis) by cineangiogram. IVUS was performed in 15 NT grafts and 14 C grafts in the short-term follow-up, and 27 NT grafts and 26 C grafts in the long-term follow-up, in grafts considered normal by the cineangiogram. The grafts were evaluated with respect to lumen volume, intimal thickness, incidence of plaque and plaque components.

Results: In the short-term follow-up, the cineangiogram showed more normal grafts (89.0% in the NT group compared with 75.0% in the C group), and the number of grafts with stenosis was 11.0% in the NT group compared with 25.0% in the C group (p = 0.006). IVUS showed less mean intimal thickness (0.43 (0.07) mm vs 0.52 (0.08) mm; p = 0.03), less grafts with considerable intimal hyperplasia (>= 0.9 mm; 20% vs 78.6%; p = 0.011) and fewer patients with considerable hyperplasia (>= 0.9 mm; 25% vs 100%; p = 0.007). In the long-term follow-up, the cineangiogram showed more normal grafts, with 91.2% in the NT group compared with 83.1% in the C group; there were fewer grafts with significant stenosis, with 7.7% in the NT group compared with 15 6% in the C group (p = 0.14). IVUS showed fewer grafts containing multiple plaques (14.8% vs 50%; p = 0.008), less advanced plaque with lipid (11.8% vs 63.9%; p = 0.0004) and less maximal plaque thickness (1.04 (0.23) mm vs 1.32 (0.25) mm; p = 0.02) in the NT group compared with the C group.

Conclusion: The superior long-term patency rate using the NT vein-graft technique at CABG could be explained by a significantly slower progression of atherosclerosis. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Keywords
CABG, Coronary artery bypass grafts, IVUS, Ischaemic heart disease, Revascularisation
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-30101 (URN)10.1016/j.ejcts.2010.02.007 (DOI)000283639200005 ()
Available from: 2013-08-01 Created: 2013-08-01 Last updated: 2018-02-05Bibliographically approved
4. The notouch pedicle vein graft for coronary artery bypass preserves the leftventricular ejection fraction 16 years after surgery: long-term datafrom a longitudinal randomized trial
Open this publication in new window or tab >>The notouch pedicle vein graft for coronary artery bypass preserves the leftventricular ejection fraction 16 years after surgery: long-term datafrom a longitudinal randomized trial
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-30104 (URN)
Available from: 2013-08-02 Created: 2013-08-02 Last updated: 2017-10-17Bibliographically approved

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Johansson, Benny

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