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The No-Touch Saphenous Vein as the Preferred Second Conduit for Coronary Artery Bypass Grafting
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardiovascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.ORCID iD: 0000-0001-5585-1783
Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
Örebro University, Örebro University School of Business.
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2013 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 96, no 1, p. 105-111Article in journal (Refereed) Published
Abstract [en]

Background. Injury incurred while saphenous veins are being obtained results in poor graft patency and impairs the results of coronary artery bypass grafting. A novel method of obtaining veins, the no-touch technique, has shown improved long-term saphenous vein graft patency. Methods. This randomized trial included 108 patients undergoing coronary artery bypass grafting and compared the patency of no-touch saphenous vein with that of radial artery grafts. Each patient was assigned to receive one no-touch saphenous vein and one radial artery graft to either the left or the right coronary territory to complement the left internal thoracic artery. Results. Angiography was performed in 99 patients (92%) at a mean of 36 months postoperatively. Graft and grafted coronary artery patency was evaluated. The patency of grafts for no-touch saphenous vein and radial artery was 94% versus 82% (p = 0.01), respectively. The patency of coronary arteries grafted with no-touch saphenous vein and radial artery grafts was 95% versus 84% (p = 0.005), respectively. Eighty-nine of 96 (93%) left internal thoracic artery grafts were patent. Conclusions. No-touch saphenous vein grafts showed a significantly higher patency rate than the radial artery grafts and the patency was comparable to the patency for left internal thoracic artery grafts. This highlights the improvement in saphenous vein graft quality with the no-touch technique and increases the number of situations in which saphenous veins may be preferable to radial artery grafts as conduits in coronary artery bypass grafting. (C) 2013 by The Society of Thoracic Surgeons

Place, publisher, year, edition, pages
2013. Vol. 96, no 1, p. 105-111
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-33269DOI: 10.1016/j.athoracsur.2013.01.102ISI: 000321741300027OAI: oai:DiVA.org:oru-33269DiVA, id: diva2:690505
Conference
Late-Breaking Clinical Trial Abstract Session at the 49th Annual Meeting of the Society-of-Thoracic-Surgeons, JAN 26-30, 2013, Los Angeles, CA
Available from: 2014-01-23 Created: 2014-01-23 Last updated: 2018-09-11Bibliographically approved
In thesis
1. Conduits in coronary artery bypass grafting surgery: Saphenous vein, radial and internal thoracic arteries
Open this publication in new window or tab >>Conduits in coronary artery bypass grafting surgery: Saphenous vein, radial and internal thoracic arteries
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate. 

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 65
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 93
Keywords
Cardiac surgery, Coronary artery bypass, Saphenous vein, Radial artery, Internal thoracic artery, Vasa vasorum, Nitric oxide, Graft patency
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-33265 (URN)978-91-7668-960-8 (ISBN)
Public defence
2013-10-11, Wilandersalen, Universitetssjukhuset, Örebro, Södra Grev Rosengatan, 703 62 Örebro, 13:15 (Swedish)
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Available from: 2014-01-23 Created: 2014-01-23 Last updated: 2017-10-17Bibliographically approved

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Dreifaldt, Mats

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