SWEDEGRAFT: Can a no-touch vein harvesting technique improve outcomes in CABG?

A no-touch vein harvesting strategy was not superior to conventional surgery in patients undergoing non-emergent coronary artery bypass grafting (CABG) in the registry-based SWEDEGRAFT trial. However, the investigational technique was associated with an increased rate of leg wound complications.

The open-label, registry-based SWEDEGRAFT trial (NCT03501303) hypothesised that no-touch vein grafts outperform conventionally harvested veins regarding graft patency and long-term clinical outcomes. To test this hypothesis, Prof. Stefan James (Uppsala University, Sweden) and colleagues randomised 900 participants from Sweden and Denmark undergoing non-emergent CABG 1:1 to the no-touch saphenous vein graft (SVG) arm or the conventional SVG arm [1]. The primary endpoint was graft failure within 2 years after CABG, defined as at least 1 SVG occluded/stenosed >50% on computed tomography angiography, PCI in a vein graft or adjacent native vessel, or death.

Although the primary endpoint was numerically in favour of the no-touch arm after a mean duration of 3.5 years following randomisation, the observed difference in primary outcome events did not reach statistical significance (19.8%, vs 24.0% in the conventional arm; difference -4.3% 95% CI -10.1 to 1.6; P=0.15). Prof. James added that the investigators did see a remarkable significant interaction effect: participants in the no-touch arm without diabetes had a lower event rate (OR 0.61; 95% CI 0.40–0.92), whereas participants in the no-touch arm with diabetes had an increased event rate (OR 2.05; 95% CI 1.08–3.88; P=0.0018), each compared with the conventional arm.

There was no significant difference between the no-touch and conventional arms with respect to major adverse cardiac events (MACE; 12.6% vs 9.9%; HR 1.30; 95% CI 0.87–1.93; P=0.20). However, leg wound complications at 3 months were significantly more common in the no-touch arm (24.7% vs 13.8%), as was the rate of participants who still had leg wound symptoms at 2 years of follow-up (49.6% vs 25.2%).

“Our trial does not support the routine use of the no-touch harvesting technique compared with the standard technique of vein handling for patients undergoing non-emergent CABG,” concluded Prof. James. “It also does not support the current ESC guideline recommendation on myocardial revascularisation that says to ‘consider no-touch vein harvesting when an open technique is used.’”

1. 
   
   1. James S, et al. No-touch vein grafts in coronary artery bypass surgery: a Nordic, randomised, registry-based clinical trial on no-touch vein grafts in coronary surgery (SWEDEGRAFT). HOTLINE 4, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

Copyright ©2024 Medicom Medical Publishers



Posted on 7 November 20247 November 2024