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  • 1.
    Caliskan, Etem
    et al.
    Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
    de Souza, Domingos Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Böning, Andreas
    Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
    Liakopoulos, Oliver J.
    Department of Cardiac and Thoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
    Choi, Yeong-Hoon
    Department of Cardiac and Thoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
    Pepper, John
    Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK.
    Gibson, C. Michael
    Boston Clinical Research Institute, Boston, MA, USA.
    Perrault, Louis P.
    Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Wolf, Randall K.
    DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
    Kim, Ki-Bong
    Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.
    Emmert, Maximilian Y.
    Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
    Saphenous vein grafts in contemporary coronary artery bypass graft surgery2019In: Nature Reviews Cardiology, ISSN 1759-5002, E-ISSN 1759-5010Article in journal (Refereed)
    Abstract [en]

    Myocardial ischaemia resulting from obstructive coronary artery disease is a major cause of morbidity and mortality in the developed world. Coronary artery bypass graft (CABG) surgery is the gold-standard treatment in many patients with complex multivessel coronary artery disease or left main disease. Despite substantial improvements in the outcome of patients undergoing CABG surgery in the past decade, graft patency remains the 'Achilles' heel' of this procedure. Whereas the use of the left internal mammary artery as a conduit is associated with the highest 10-year patency rate (>90%), saphenous vein grafts - the most commonly used conduit in CABG surgery - fail in 40-50% of treated patients by 10 years after surgery. Vein graft disease (VGD) and failure result from complex pathophysiological processes that can lead to complete occlusion of the graft, affecting long-term clinical outcomes. Optimal harvesting techniques, intraoperative preservation strategies and intraoperative patency control have important roles in the prevention of VGD. In addition, several studies published in the past decade have reported similar mid-term patency rates between vein grafts and arterial grafts when veins are used as a composite graft based on the internal mammary artery. In this Review, we present the latest evidence on the utilization of saphenous vein grafts for CABG surgery and provide an overview of the current practices for the prevention of VGD and vein graft failure.

  • 2.
    Deb, Saswata
    et al.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    Singh, Steve K.
    Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
    de Souza, Domingos Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Chu, Michael W. A.
    Department of Surgery, Western University, London Health Sciences Centre, London, Canada.
    Whitlock, Richard
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Meyer, Steven R.
    Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
    Verma, Subodh
    St. Michael's Hospital, Toronto, Canada.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Al-Saleh, Ayman
    McMaster University, Hamilton, Canada.
    Brady, Katheryn
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Rao-Melacini, Purnima
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Belley-Cote, Emilie P.
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Tam, Derrick Y.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    Devereaux, P. J.
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Novick, Richard J.
    University of Calgary and Foothills Medical Centre, Calgary, Canada.
    Fremes, Stephen E.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)2019In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 14, no 1, article id 85Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Single centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG).

    METHODS: Adults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results.

    RESULTS: Two hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p = 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%), p = 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%, p < 0.01). Including this study's results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29-0.82, p = 0.007 in 3 randomized and 1 observational study at 1 year postoperatively.

    CONCLUSIONS: The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting.

    TRIAL REGISTRATION: NCT01047449 .

  • 3.
    Kim, Ki-Bong
    et al.
    Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.
    Hwang, Ho Young
    Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.
    de Souza, Domingos Savio Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Taggart, David Paul
    Department of Cardiovascular Surgery, University of Oxford, London, UK.
    Saphenous vein: advances2018In: Indian Journal of Thoracic and Cardiovascular Surgery, ISSN 0970-9134, Vol. 34, no Suppl. 3, p. 251-257Article, review/survey (Refereed)
    Abstract [en]

    Although the saphenous vein (SV) is a widely used conduit for coronary artery bypass graft surgery (CABG), lower long-term graft patency rates and worse clinical outcomes have been reported after CABG performed with SV grafts compared with CABG performed with internal thoracic artery (ITA) grafts. Of various efforts to overcome the limitations of SV that are resulting from structural and functional differences from arterial conduit, recent improvement in harvesting techniques including no-touch technique, surgical strategy of using the SV as part of a composite graft over an aortocoronary bypass graft, and external stenting of the SV will be discussed in this topic.

  • 4.
    Kopjar, Tomislav
    et al.
    Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
    Dashwood, Michael Richard
    Surgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical School, London, UK.
    Dreifaldt, Mats
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    de Souza, Domingos Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    No-touch saphenous vein as an important conduit of choice in coronary bypass surgery2018In: Journal of Thoracic Disease, ISSN 2072-1439, E-ISSN 2077-6624, Vol. 10, no Suppl. 26, p. S3292-S3296Article in journal (Other academic)
  • 5.
    Samano, Ninos
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Dashwood, Michael
    Surgical and Interventional Sciences, Royal Free Hospital Campus, University College London Medical School, London, UK.
    de Souza, Domingos Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    No-touch vein grafts and the destiny of venous revascularization in coronary artery bypass grafting-a 25th anniversary perspective2018In: Annals of cardiothoracic surgery, ISSN 2225-319X, Vol. 7, no 5, p. 681-685Article in journal (Refereed)
    Abstract [en]

    Ischemic heart disease is currently the leading cause of death globally, with coronary artery bypass grafting among the most common operations performed worldwide. More extensive use of arterial grafts has been advocated because of their high long-term patency, long-term survival benefit, and freedom from reinterventions. Despite this, the saphenous vein is the most frequently used conduit in patients undergoing coronary artery bypass surgery since its introduction over 50 years ago. Consequently, the saphenous vein remains an indispensable conduit in coronary artery bypass grafting and maintaining its long-term patency is one of the most crucial challenges in cardiovascular surgery. This situation led to the development of the no-touch saphenous vein harvesting technique, where the vein is harvested completely with its pedicle of surrounding tissue. Several studies report a superior long-term patency rate, slower progression of atherosclerosis, and better clinical outcomes whilst employing no-touch harvesting technique. The success of the technique is multifactorial, including the decreased risk for graft spasm-and the need for manual distension-preservation of the vaso vasorum and an intact endothelium, reducing neointimal hyperplasia and subsequent atherosclerosis. Furthermore, the intact perivascular tissue, including the surrounding cushion of fat, may act as a "natural external stem", providing mechanical support preventing the graft from kinking. We arc convinced that the use of arterial grafts, in combination with the no-touch saphenous vein graft, will significantly improve the results of coronary artery bypass grafting. This is important for achieving a comprehensive and evidence-based balance between the major treatment strategies of ischemic heart disease, explicitly coronary artery bypass grafting and percutaneous coronary intervention. The no-touch technique is becoming increasingly popular among surgeons, with further studies to be initiated worldwide.

  • 6.
    Samano, Ninos
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, University Health Care Research Center.
    Pinheiro, Bruno Botelho
    Department Cardiovascular Surgery, Hospital do Coração Anis Rassi, Goiânia, GO, Brazil.
    de Souza, Domingos Ramos
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Surgical Aspects of No-Touch Saphenous Vein Graft Harvesting in CABG: Clinical and Angiographic Follow-Up at 3 Months2019In: Brazilian Journal of Cardiovascular Surgery, ISSN 0102-7638, E-ISSN 1678-9741, Vol. 34, no 1, p. 98-100Article in journal (Refereed)
    Abstract [en]

    With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.

1 - 6 of 6
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