Yong Han Kim1, Hong Chul Oh1, Jae Woong Choi1, Ho Young Hwang1, Ki-Bong Kim2. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. 2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. Electronic address: kimkb@snu.ac.kr.
Abstract
BACKGROUND: Harvesting technique and surgical strategy may affect patency rates of saphenous vein (SV) grafts in coronary artery bypass graft surgery (CABG). We evaluated early clinical outcomes and 1-year graft patency rates of SV grafts that were harvested with a no-touch technique and used as composite grafts. METHODS:Three hundred sixty-eight patients who underwent off-pump CABG using SV composite grafts based on the left internal thoracic artery were studied. The results of 103 patients who received SV grafts harvested with a "no-touch" technique (group NT) were compared with the results of 265 patients who receivedSV grafts harvested with a "minimal manipulation" technique (group MM). A propensity score-matched analysis was also performed to minimize differences in preoperative and intraoperative variables (n = 98 in each group). Early clinical outcomes and early and 1-year postoperative angiographic results were compared. RESULTS: No differences in early mortality or postoperative complications were observed between the two groups. Early postoperative (1.6 ± 2.2 days) angiography demonstrated a significantly higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 100% versus 97.2%, p = 0.002; after, 100% versus 97.7%, p = 0.003). One-year postoperative (13.0 ± 2.5 months) angiography also showed a higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 97.4% versus 92.4%, p = 0.024; after, 97.3% versus 92.6%, p = 0.051). CONCLUSIONS: The SV grafts harvested with a no-touch technique further improved the early and 1-year patency of SV composite grafts. Midterm and long-term angiographic follow-up may be warranted to demonstrate the superiority of no-touch SV composite grafts.
RCT Entities:
BACKGROUND: Harvesting technique and surgical strategy may affect patency rates of saphenous vein (SV) grafts in coronary artery bypass graft surgery (CABG). We evaluated early clinical outcomes and 1-year graft patency rates of SV grafts that were harvested with a no-touch technique and used as composite grafts. METHODS: Three hundred sixty-eight patients who underwent off-pump CABG using SV composite grafts based on the left internal thoracic artery were studied. The results of 103 patients who received SV grafts harvested with a "no-touch" technique (group NT) were compared with the results of 265 patients who received SV grafts harvested with a "minimal manipulation" technique (group MM). A propensity score-matched analysis was also performed to minimize differences in preoperative and intraoperative variables (n = 98 in each group). Early clinical outcomes and early and 1-year postoperative angiographic results were compared. RESULTS: No differences in early mortality or postoperative complications were observed between the two groups. Early postoperative (1.6 ± 2.2 days) angiography demonstrated a significantly higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 100% versus 97.2%, p = 0.002; after, 100% versus 97.7%, p = 0.003). One-year postoperative (13.0 ± 2.5 months) angiography also showed a higher patency rate of SV grafts in group NT than in group MM before and after propensity score matching (before, 97.4% versus 92.4%, p = 0.024; after, 97.3% versus 92.6%, p = 0.051). CONCLUSIONS: The SV grafts harvested with a no-touch technique further improved the early and 1-year patency of SV composite grafts. Midterm and long-term angiographic follow-up may be warranted to demonstrate the superiority of no-touch SV composite grafts.
Authors: Etem Caliskan; Domingos Ramos de Souza; Andreas Böning; Oliver J Liakopoulos; Yeong-Hoon Choi; John Pepper; C Michael Gibson; Louis P Perrault; Randall K Wolf; Ki-Bong Kim; Maximilian Y Emmert Journal: Nat Rev Cardiol Date: 2019-08-27 Impact factor: 32.419