No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial

Stefan Thelin; Ivy Susanne Modrau; Olov Duvernoy; Magnus Daln; Mats Dreifaldt; Anders Ericsson; Örjan Friberg; Anders Holmgren; Per Hostrup Nielsen; Henrik Hultkvist; Karin Jensevik Eriksson; Anders Jeppsson; Mats Lidn; Shahab Nozohoor; Sigurdur Ragnarsson; Ulrik Sartipy; Lisa Ternström; Raquel Themudo; Per Vikholm; Stefan James

doi:10.1093/eurheartj/ehaf018

No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial

Stefan Thelin, Ivy Susanne Modrau, Olov Duvernoy, Magnus Daln, Mats Dreifaldt, Anders Ericsson, Örjan Friberg, Anders Holmgren, Per Hostrup Nielsen, Henrik Hultkvist, Karin Jensevik Eriksson, Anders Jeppsson, Mats Lidn, Shahab Nozohoor, Sigurdur Ragnarsson, Ulrik Sartipy, Lisa Ternström, Raquel Themudo, Per Vikholm, Stefan James^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.

Original language	English
Journal	European Heart Journal
Volume	46
Issue	18
Pages (from-to)	1720-1729
Number of pages	10
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehaf018
Publication status	Published - 7 May 2025

Keywords

Coronary artery disease
Long-term outcomes
Mortality
Myocardial infarction
Surgical complications

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Thelin, S., Modrau, I. S., Duvernoy, O., Daln, M., Dreifaldt, M., Ericsson, A., Friberg, Ö., Holmgren, A., Hostrup Nielsen, P., Hultkvist, H., Jensevik Eriksson, K., Jeppsson, A., Lidn, M., Nozohoor, S., Ragnarsson, S., Sartipy, U., Ternström, L., Themudo, R., Vikholm, P., & James, S. (2025). No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial. European Heart Journal, 46(18), 1720-1729. https://doi.org/10.1093/eurheartj/ehaf018

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title = "No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial",

abstract = "Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.",

keywords = "Coronary artery disease, Long-term outcomes, Mortality, Myocardial infarction, Surgical complications",

author = "Stefan Thelin and Modrau, {Ivy Susanne} and Olov Duvernoy and Magnus Daln and Mats Dreifaldt and Anders Ericsson and {\"O}rjan Friberg and Anders Holmgren and {Hostrup Nielsen}, Per and Henrik Hultkvist and {Jensevik Eriksson}, Karin and Anders Jeppsson and Mats Lidn and Shahab Nozohoor and Sigurdur Ragnarsson and Ulrik Sartipy and Lisa Ternstr{\"o}m and Raquel Themudo and Per Vikholm and Stefan James",

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year = "2025",

month = may,

day = "7",

doi = "10.1093/eurheartj/ehaf018",

language = "English",

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Thelin, S, Modrau, IS, Duvernoy, O, Daln, M, Dreifaldt, M, Ericsson, A, Friberg, Ö, Holmgren, A, Hostrup Nielsen, P, Hultkvist, H, Jensevik Eriksson, K, Jeppsson, A, Lidn, M, Nozohoor, S, Ragnarsson, S, Sartipy, U, Ternström, L, Themudo, R, Vikholm, P & James, S 2025, 'No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial', European Heart Journal, vol. 46, no. 18, pp. 1720-1729. https://doi.org/10.1093/eurheartj/ehaf018

No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial. / Thelin, Stefan; Modrau, Ivy Susanne; Duvernoy, Olov et al.
In: European Heart Journal, Vol. 46, No. 18, 07.05.2025, p. 1720-1729.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - No-touch vein grafts in coronary artery bypass surgery

T2 - a registry-based randomized clinical trial

AU - Thelin, Stefan

AU - Modrau, Ivy Susanne

AU - Duvernoy, Olov

AU - Daln, Magnus

AU - Dreifaldt, Mats

AU - Ericsson, Anders

AU - Friberg, Örjan

AU - Holmgren, Anders

AU - Hostrup Nielsen, Per

AU - Hultkvist, Henrik

AU - Jensevik Eriksson, Karin

AU - Jeppsson, Anders

AU - Lidn, Mats

AU - Nozohoor, Shahab

AU - Ragnarsson, Sigurdur

AU - Sartipy, Ulrik

AU - Ternström, Lisa

AU - Themudo, Raquel

AU - Vikholm, Per

AU - James, Stefan

PY - 2025/5/7

Y1 - 2025/5/7

N2 - Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.

AB - Background and Aims: No-touch saphenous vein harvesting may enhance graft patency and improve clinical outcomes after coronary artery bypass grafting (CABG). Methods: In this registry-based, randomized trial, patients undergoing CABG were randomly assigned to no-touch or conventional harvesting. The primary composite outcome was the proportion of patients with occluded/stenosed >50% vein graft on coronary computed tomography angiography, or who underwent percutaneous coronary intervention to a vein graft, or died. Secondary outcomes included clinical outcomes and leg wound complications. Results: A total of 902 patients were enrolled with a mean total number of distal vein anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454 (19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of patients randomized to the conventional technique [difference, -4.3 percentage points; 95% confidence interval (CI) -10.1-1.6; P =. 15] at a mean follow-up time of 3.5 (SD 0.1) years. The composite of death, myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93). Leg wound complications were more common in patients assigned to no-touch harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference, 10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs. 91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage points; 95% CI 17.7-31.1). Conclusions: No-touch vein graft harvesting for CABG was not superior to conventional open harvesting in reducing vein graft failure or clinical events after CABG but increased leg wound complications. The primary outcome requires cautious interpretation due to a lower-than-expected number of primary events.

KW - Coronary artery disease

KW - Long-term outcomes

KW - Mortality

KW - Myocardial infarction

KW - Surgical complications

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U2 - 10.1093/eurheartj/ehaf018

DO - 10.1093/eurheartj/ehaf018

M3 - Journal article

C2 - 39969129

AN - SCOPUS:105004749799

SN - 0195-668X

VL - 46

SP - 1720

EP - 1729

JO - European Heart Journal

JF - European Heart Journal

IS - 18

ER -

No-touch vein grafts in coronary artery bypass surgery: a registry-based randomized clinical trial

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