No-touch technique in coronary artery bypass grafting: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Xiaoyu ^1,2 , GUO Jiong ¹ , HUANG Chen ¹ , SHU Liliang ¹ ,  XU Jing ¹

1. The Third Department of Cardiac Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P.R.China;
2. Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China;

Corresponding author：

XU Jing, Email: xujing00111@sina.com

Keywords：

Saphenous vein; coronary artery bypass graft surgery; no-touch technique

DOI：

10.7507/1007-4848.201712009

Video：

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Objective To compare the patency of the postoperative vessel bridge grafts between the no-touch technique and the conventional technique for saphenous vein harvest in the coronary artery bypass grafting. Methods A total of 70 patients underwent coronary artery bypass grafting from January 2014 to January 2015 in the First Affiliated Hospital of Zhengzhou University. They were randomly divided into a conventional technique group (saphenous vein obtained by traditional technique) and a no-touch technique group (saphenous vein obtained by no-touch technique). There were 34 patients in the conventional technique group, including 16 males and 18 females with an average age of 61.6±6.4 years. There were 36 patients in the no-touch technique group, including 16 males and 20 females with an average age of 62.2±6.6 years. The 1-year postoperative coronary CT angiography (CTA) results were compared. Results Seventy patients underwent coronary CTA examination 1 year postoperatively. The patency rate of the conventional technique group and no-touch technique group were 83/116 (71.6%) and 113/122 (92.6%). Logistic regression analysis showed a statistical difference between the non-touch technique and the conventional technique (P<0.05). Conclusion The short-term patency rate of vessel bridge grafts is higher when the no-touch technique is used.

Citation： ZHOU Xiaoyu, GUO Jiong, HUANG Chen, SHU Liliang, XU Jing. No-touch technique in coronary artery bypass grafting: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 875-879. doi: 10.7507/1007-4848.201712009 Copy

1.	Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
2.	Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
3.	胡盛寿, 郑哲, 周玉燕. 常规与非体外循环冠状动脉旁路移植术治疗冠状动脉多支病变的对比分析. 中国胸心血管外科临床杂志, 2000, 7(4): 221-224.
4.	Campeau L, Enjalbert M, Lespérance J, et al. Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation, 1983, 68(3 Pt 2): I1-I7.
5.	Izzat MB, West RR, Bryan AJ, et al. Coronary artery bypass surgery: current practice in the United Kingdom. Br Heart J, 1994, 71(4): 382-385.
6.	Cooper GJ, Underwood MJ, Deverall PB. Arterial and venous conduits for coronary artery bypass. A current review. Eur J Cardiothorac Surg, 1996, 10(2): 129-140.
7.	Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
8.	Parang P, Arora R. Coronary vein graft disease: pathogenesis and prevention. Can J Cardiol, 2009, 25(2): e57-e62.
9.	Samano N, Geijer H, Liden M, et al. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg, 2015, 150(4): 880-888.
10.	Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease. Operative technique. J Thorac Cardiovasc Surg, 1969, 58(2): 178-185.
11.	Kim YH, Oh HC, Choi JW, et al. No-touch saphenous vein harvesting may improve further the patency of saphenous vein composite grafts: early outcomes and 1-year angiographic results. Ann Thorac Surg, 2017, 103(5): 1489-1497.
12.	Rueda Fd, Souza D, Lima Rde C, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol, 2008, 90(6): 356-362.
13.	Tsui JC, Souza DS, Filbey D, et al. Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel "no-touch" technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg, 2002, 35(2): 356-362.
14.	Khaleel MS, Dorheim TA, Duryee MJ, et al. High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure. Ann Thorac Surg, 2012, 93(2): 552-558.
15.	Nolte A, Secker S, Walker T, et al. Veins are no arteries: even moderate arterial pressure induces significant adhesion molecule expression of vein grafts in an ex vivo circulation model. J Cardiovasc Surg (Torino), 2011, 52(2): 251-259.
16.	Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation, 1998, 97(9): 916-931.
17.	Cox JL, Chiasson DA, Gotlieb AI. Stranger in a strange land: the pathogenesis of saphenous vein graft stenosis with emphasis on structural and functional differences between veins and arteries. Prog Cardiovasc Dis, 1991, 34(1): 45-68.
18.	Fan T, Feng Y, Feng F, et al. A comparison of postoperative morphometric and hemodynamic changes between saphenous vein and left internal mammary artery grafts. Physiol Rep, 2017, 5(21): pii: e13487.
19.	Dashwood MR, Loesch A. The saphenous vein as a bypass conduit: the potential role of vascular nerves in graft performance. Curr Vasc Pharmacol, 2009, 7(1): 47-57.
20.	Siow RC, Churchman AT. Adventitial growth factor signalling and vascular remodelling: potential of perivascular gene transfer from the outside-in. Cardiovasc Res, 2007, 75(4): 659-668.
21.	Dashwood MR, Savage K, Tsui JC, et al. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg, 2009, 138(2): 334-340.
22.	Maurice G, Wang X, Lehalle B, et al. Modeling of elastic deformation and vascular resistance of arterial and venous vasa vasorum. J Mal Vasc, 1998, 23(4): 282-288.
23.	张岩, 孙寒松, 胡盛寿. 不接触技术对冠状动脉旁路移植术后静脉桥通畅率影响的进展. 中国胸心血管外科临床杂志, 2016, 23(8): 827-831.

1. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
3. 胡盛寿, 郑哲, 周玉燕. 常规与非体外循环冠状动脉旁路移植术治疗冠状动脉多支病变的对比分析. 中国胸心血管外科临床杂志, 2000, 7(4): 221-224.
4. Campeau L, Enjalbert M, Lespérance J, et al. Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation, 1983, 68(3 Pt 2): I1-I7.
5. Izzat MB, West RR, Bryan AJ, et al. Coronary artery bypass surgery: current practice in the United Kingdom. Br Heart J, 1994, 71(4): 382-385.
6. Cooper GJ, Underwood MJ, Deverall PB. Arterial and venous conduits for coronary artery bypass. A current review. Eur J Cardiothorac Surg, 1996, 10(2): 129-140.
7. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
8. Parang P, Arora R. Coronary vein graft disease: pathogenesis and prevention. Can J Cardiol, 2009, 25(2): e57-e62.
9. Samano N, Geijer H, Liden M, et al. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg, 2015, 150(4): 880-888.
10. Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease. Operative technique. J Thorac Cardiovasc Surg, 1969, 58(2): 178-185.
11. Kim YH, Oh HC, Choi JW, et al. No-touch saphenous vein harvesting may improve further the patency of saphenous vein composite grafts: early outcomes and 1-year angiographic results. Ann Thorac Surg, 2017, 103(5): 1489-1497.
12. Rueda Fd, Souza D, Lima Rde C, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol, 2008, 90(6): 356-362.
13. Tsui JC, Souza DS, Filbey D, et al. Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel "no-touch" technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg, 2002, 35(2): 356-362.
14. Khaleel MS, Dorheim TA, Duryee MJ, et al. High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure. Ann Thorac Surg, 2012, 93(2): 552-558.
15. Nolte A, Secker S, Walker T, et al. Veins are no arteries: even moderate arterial pressure induces significant adhesion molecule expression of vein grafts in an ex vivo circulation model. J Cardiovasc Surg (Torino), 2011, 52(2): 251-259.
16. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation, 1998, 97(9): 916-931.
17. Cox JL, Chiasson DA, Gotlieb AI. Stranger in a strange land: the pathogenesis of saphenous vein graft stenosis with emphasis on structural and functional differences between veins and arteries. Prog Cardiovasc Dis, 1991, 34(1): 45-68.
18. Fan T, Feng Y, Feng F, et al. A comparison of postoperative morphometric and hemodynamic changes between saphenous vein and left internal mammary artery grafts. Physiol Rep, 2017, 5(21): pii: e13487.
19. Dashwood MR, Loesch A. The saphenous vein as a bypass conduit: the potential role of vascular nerves in graft performance. Curr Vasc Pharmacol, 2009, 7(1): 47-57.
20. Siow RC, Churchman AT. Adventitial growth factor signalling and vascular remodelling: potential of perivascular gene transfer from the outside-in. Cardiovasc Res, 2007, 75(4): 659-668.
21. Dashwood MR, Savage K, Tsui JC, et al. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg, 2009, 138(2): 334-340.
22. Maurice G, Wang X, Lehalle B, et al. Modeling of elastic deformation and vascular resistance of arterial and venous vasa vasorum. J Mal Vasc, 1998, 23(4): 282-288.
23. 张岩, 孙寒松, 胡盛寿. 不接触技术对冠状动脉旁路移植术后静脉桥通畅率影响的进展. 中国胸心血管外科临床杂志, 2016, 23(8): 827-831.

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No-touch technique in coronary artery bypass grafting: A randomized controlled trial

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