No-touch vein harvesting has meaningful benefits for heart bypass patients

(Press-News.org) ‘No-touch’ vein harvesting significantly reduces the risk of graft failure up to three years after coronary artery bypass surgery compared with conventionally harvested vein grafts, finds a study from China published by The BMJ today.

The no-touch technique also translates into meaningful clinical benefits for patients, such as lower rates of heart attacks and need for repeat revascularisation (a procedure to restore blood flow to blocked veins), say the researchers.

A coronary artery bypass graft (CABG) is a surgical procedure used to improve blood flow and oxygen supply to the heart in patients with coronary heart disease. It involves grafting a healthy blood vessel from another part of the body (usually the saphenous vein in the lower leg) to the coronary artery. 

The conventional vein harvesting technique, which strips the vein of surrounding tissue before grafting, is linked to high graft occlusion rates (where the vein becomes blocked or narrowed, impeding blood flow). 

The no-touch technique, however, harvests the vein with a cushion of surrounding tissue and showed significantly lower occlusion rates at 3 and 12 months after surgery in the PATENCY trial. But the long-term effects of this technique are still uncertain.

To address this evidence gap, researchers carried out a three-year follow-up of the PATENCY trial to assess longer term outcomes of the no-touch vein harvesting technique compared with the conventional approach.

Their findings are based on 2,655 patients (average age 61; 22% women) undergoing CABG at seven cardiac surgery centres in China who were randomly assigned to receive no-touch vein harvesting (1,337) or the conventional technique (1,318).

At three years, the no-touch group showed a significantly lower vein graft occlusion rate than the conventional group (5.7% v 9%).

Several other outcomes - including rates of non-fatal heart attack, repeat revascularisation, recurrent angina, and readmission to hospital for cardiac reasons - were also significantly reduced in the no-touch group (1.2% v 2.7%, 1.1% v 2.2%, 6.2% v 8.4%, and 7.1% v 10.2% respectively), reinforcing the potential clinical benefits of the no-touch technique.

There were no significant differences in cause death or major adverse cardiac and cerebrovascular events.

The researchers acknowledge several limitations and say it is possible that these findings reflect random variation rather than a true biological effect. The study also focused on relatively young people in China, so findings may not apply to other nationalities and age groups.

However, they point out that results were consistent after further analyses and suggest they have important implications for clinical practice and guideline development.

They conclude: “This study provides robust evidence supporting the use of the no-touch technique to reduce the risk of vein graft occlusion, a critical factor in the long term success of CABG surgery. The decreased rates of vein graft occlusion observed in the no-touch group translate into meaningful clinical benefits, as demonstrated by the lower incidences of non-fatal myocardial infarction and repeat revascularisation.”

This study “provides important evidence on the durability and clinical outcomes associated with the no-touch technique,” writes Hui Jiang, professor of cardiac surgery at Shengjing Hospital of China Medical University, in a linked editorial.

Despite some study limitations and the need for ongoing follow-up and detailed assessment of individual clinical events, he says “these findings might help shape future surgical strategies and inform updates to clinical guidelines.”

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