SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)

Saswata Deb, Steve K Singh, Domingos de Souza, Michael W A Chu, 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, SUPERIOR SVG Study Investigators, Saswata Deb, Steve K Singh, Domingos de Souza, Michael W A Chu, 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, SUPERIOR SVG Study Investigators

Abstract

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 .

Keywords: Conventional open saphenous vein graft harvesting; Coronary artery bypass grafting surgery; Endoscopic saphenous vein graft harvesting; Graft patency; Major adverse cardiac and cerebrovascular outcomes; Multi-centred randomized controlled trial; No touch atraumatic saphenous vein graft harvesting.

Conflict of interest statement

Ethics approval and consent to participate

The ethics committees at each participating centre approved the trial, and all participants provided written informed consent.

Consent for publication

All investigators have reviewed the manuscript and approve for publication. Data are presented of the cohort of participants in each arm. No individual patient data are presented.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort diagram of the surgical arm (No touch versus Conventional technique)
Fig. 2
Fig. 2
Kaplan Meier plot of the secondary outcome, MACCE (major adverse cardiac and cerebrovascular events (death, non-fatal myocardial infarction, stroke, repeat revascularization)), between the No Touch and Conventional groups
Fig. 3
Fig. 3
a Forest plot for early vein graft occlusion at median 1 year reported follow-up between No Touch technique and Conventional SVG harvesting technique. The graft occlusion results from the current study refer to the study saphenous veins according to the allocated treatment. b Forest plot for early vein graft occlusion or significant stenosis (> 50% narrowing of lumen) at median 1 year reported follow-up between No Touch technique and Conventional SVG harvesting technique. The graft occlusion results from the current study refer to the study saphenous veins according to the allocated treatment
Fig. 4
Fig. 4
a Meta-analysis of no touch versus conventional saphenous vein graft harvesting technique for the outcome of any graft occlusion. b Meta-analysis of no touch versus conventional saphenous vein graft harvesting technique for the outcome any graft occlusion or significant stenosis

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Source: PubMed

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