• Saswata Deb, Steve K Singh, Domingos de Souza, Chu Michael W A MWA Department of Surgery, Western University, London Health Sciences Centre, London, Canada., Richard Whitlock, Steven R Meyer, Subodh Verma, Anders Jeppsson, Ayman Al-Saleh, Katheryn Brady, Purnima Rao-Melacini, Emilie P Belley-Cote, Derrick Y Tam, P J Devereaux, Richard J Novick, Stephen E Fremes, and SUPERIOR SVG Study Investigators.
• Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, 2075 Bayview Ave., Room H405, Toronto, ON, M4N 3M5, Canada.
• J Cardiothorac Surg. 2019 May 2; 14 (1): 85.

BackgroundSingle 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).MethodsAdults 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.ResultsTwo 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.ConclusionsThe 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 RegistrationNCT01047449 .

13 keywords...

hide…