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No-Touch Saphenous Veins in Coronary Artery Bypass Grafting: Long-term Angiographic, Surgical, and Clinical Aspects
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-4249-8401
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ischemic heart disease is currently the leading cause of death globally. Coronary artery bypass grafting (CABG) is considered the best treatment for many patients and its success depends on the long-term patency of the conduits. Greater use of arterial grafts has been advocated because of their higher long-term patency compared to saphenous vein grafts (SVGs). Despite this, SVGs account for up to 80% of all grafts used in CABG. Consequently, the long-term patency of the saphenous vein (SV) is one of the most crucial challenges in cardiovascular surgery. The no-touch (NT) SV in CABG has shown a superior patency rate, slower progression of atherosclerosis, and better clinical outcome compared to conventional veins up to 8.5 years postoperatively. The aim of this thesis was to study the long-term angiographic, echocardiographic, and clinical aspects of CABG patients receiving either NT or conventional vein grafts and to investigate the health-related quality of life (HRQoL) in this patient group. Studies I-II report a randomized trial between NT and conventional veins where 74 patients were followed-up at a mean of 16 years postoperatively. Study III is a prospective cohort trial in which 97 patients with NT vein grafts anastomosed to the left anterior descending artery (LAD) were included and followed-up at a mean of 6 years postoperatively. Study IV included 257 patients in whom HRQoL and graft patency were studied during the same follow-up visit. Overall, NT vein grafts showed a higher patency compared to conventional veins at a mean of 16 years, 83% vs. 64% (p=0.03), which was similar to the patency of the left internal thoracic artery, 88%. The NT group had a better left ventricular ejection fraction compared to the conventional group, 57.9% vs. 49.4% (p=0.011). After a mean of 6 years, the patency rate of NT SVs to the LAD was 95.6% and to non-LAD targets, 93.9%. Graft patency was an independent predictor of HRQoL in CABG patients. These patients reported a function and wellbeing similar to that of the Swedish population and clearly higher health status than those in the same disease group in the general population.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2016. , p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 145
Keywords [en]
Computed tomography angiography, coronary artery bypass grafting, left internal thoracic artery, no-touch harvesting technique, patency, saphenous vein
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-50039ISBN: 978-91-7529-137-6 (print)OAI: oai:DiVA.org:oru-50039DiVA, id: diva2:924783
Public defence
2016-06-17, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2018-04-27Bibliographically approved
List of papers
1. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial
Open this publication in new window or tab >>The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial
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2015 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 150, no 4, p. 880-888Article in journal (Refereed) Published
Abstract [en]

Objectives: This study investigates whether the no-touch (NT) vein graft, at a mean time of 16 years, maintains a significantly higher patency rate than conventional (C) vein grafts and still has patency comparable to that of the left internal thoracic artery (LITA).

Methods: A total of 156 patients accepted for coronary artery bypass grafting were randomly allocated to 1 of 3 groups. In the C group, the saphenous vein (SV) was stripped and distended. In the intermediate group, the SV was stripped but not distended. In the NT group, the SV was neither stripped nor distended, but rather harvested with a fat pedicle. This study is an angiographic follow-up of the C and NT groups, at a mean time of 16 years postoperatively.

Results: Fifty-four patients were included (C group = 27; NT group = 27). In all, 72 and 75 vein grafts were completed in groups C and NT, respectively. Crude SV graft patency was 64% in the C group versus 83% in the NT group (P = .03), which was similar to the patency of the LITA (88%). The harvesting technique had a major impact on the patency with a hazard ratio for occlusion of 1.83 for the C group (P = .04).

Conclusions: Harvesting the SV with the NT technique conferred, at a mean time of 16 years, a significantly higher patency than the conventional technique that was still comparable to that of the LITA.

Place, publisher, year, edition, pages
Mosby-Elsevier, 2015
Keywords
Coronary artery bypass grafting, Left internal thoracic artery, Saphenous vein graft
National Category
Surgery Cardiac and Cardiovascular Systems
Research subject
Surgery esp. Thoracic and Cardivascular Surgery; Cardiology
Identifiers
urn:nbn:se:oru:diva-45715 (URN)10.1016/j.jtcvs.2015.07.027 (DOI)000361900500040 ()26282605 (PubMedID)2-s2.0-84942838761 (Scopus ID)
Projects
Avhandlingsarbete
Note

Funding Agencies:

Örebro County Council, through the regional research board

Nyckelfonden OLL-116951

Available from: 2015-09-03 Created: 2015-09-03 Last updated: 2018-07-01Bibliographically approved
2. The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial
Open this publication in new window or tab >>The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial
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2015 (English)In: Open Heart, ISSN 2053-3624, Vol. 2, no 1, article id e000204Article in journal (Refereed) Published
Place, publisher, year, edition, pages
London, United Kingdom: BMJ Group, 2015
National Category
Surgery
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
urn:nbn:se:oru:diva-44412 (URN)10.1136/openhrt-2014-000204 (DOI)25852948 (PubMedID)
Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2018-09-06Bibliographically approved
3. The no-touch saphenous vein graft in high-risk coronary bypass patients is a reliable conduit to substitute the left internal thoracic artery
Open this publication in new window or tab >>The no-touch saphenous vein graft in high-risk coronary bypass patients is a reliable conduit to substitute the left internal thoracic artery
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-50369 (URN)
Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2017-10-17Bibliographically approved
4. Graft patency is a predictor of health-related quality of life after coronary artery bypass surgery
Open this publication in new window or tab >>Graft patency is a predictor of health-related quality of life after coronary artery bypass surgery
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-50378 (URN)
Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2017-10-17Bibliographically approved

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Samano, Ninos

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