oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
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
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Show others and affiliations
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.

Place, publisher, year, edition, pages
2010. Vol. 38, no 4, p. 414-419
Keywords [en]
CABG, Coronary artery bypass grafts, IVUS, Ischaemic heart disease, Revascularisation
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-30101DOI: 10.1016/j.ejcts.2010.02.007ISI: 000283639200005OAI: oai:DiVA.org:oru-30101DiVA, id: diva2:638725
Available from: 2013-08-01 Created: 2013-08-01 Last updated: 2018-02-05Bibliographically approved
In thesis
1. 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
Open this publication in new window or tab >>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
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
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:nbn:se:oru:diva-28426 (URN)978-91-7668-928-8 (ISBN)
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

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full text

Authority records BETA

Johansson, Benny L.Bodin, LennartGeijer, Håkan

Search in DiVA

By author/editor
Johansson, Benny L.Souza, Domingos S. R.Bodin, LennartGeijer, Håkan
By organisation
School of Health and Medical Sciences, Örebro University, Sweden
In the same journal
European Journal of Cardio-Thoracic Surgery
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 213 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf