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

Saswata Deb,On Behalf Of The Superior Svg Study Investigators ,Derrick Y Tam,Michael W A Chu,Subodh Verma,P J Devereaux,Purnima Rao-Melacini,Ayman Al-Saleh,Stephen E Fremes,Emilie P Belley-Cote,Richard Whitlock,Steven R Meyer,Domingos De Souza,Anders Jeppsson,Steve K Singh,Katheryn Brady,Richard J Novick

doi:10.1186/s13019-019-0887-x

Abstract

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.

Highlights

Graft patency is an important determinant of long-term clinical success after coronary artery bypass graft surgery (CABG) [1]
The atraumatic No Touch technique (NT) of harvesting the saphenous vein graft (SVG) with its pedicle intact has been shown to result in favorable biochemical and histological properties of the NT SVG compared to the conventional (CON) SVG technique [5,6,7,8]
A single-centre randomized controlled trial (RCT) demonstrated that early [9] (18 months, NT: 95.4%, CON: 88.9%, p = 0.03), mid-term [10] (8.5 years, NT 90%, CON: 76%, p = 0.01) and late [11] (16 years, NT: 83%, CON: 64%, p = 0.03) SVG patency was superior in NT compared to CON SVGs

Summary

Introduction

Graft patency is an important determinant of long-term clinical success after coronary artery bypass graft surgery (CABG) [1]. The most common utilized conduit in CABG continues to be the saphenous vein graft (SVG). A single-centre randomized controlled trial (RCT) demonstrated that early [9] (18 months, NT: 95.4%, CON: 88.9%, p = 0.03), mid-term [10] (8.5 years, NT 90%, CON: 76%, p = 0.01) and late [11] (16 years, NT: 83%, CON: 64%, p = 0.03) SVG patency was superior in NT compared to CON SVGs. The evidence in support of this potentially very important treatment effect has been derived from single centre investigations [9,10,11,12,13,14] to date. 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

Results

Discussion

Conclusion