| 1. |
- Dreifaldt, Mats, et al.
(författare)
-
The ‘‘no-touch’’ harvesting technique for vein grafts in coronary artery bypass surgery preserves an intact vasa vasorum
- 2011
-
Ingår i: The Internet Journal of Thoracic and Cardiovascular Surgery. - New York, USA : Elsevier. - 1524-0274 .- 0022-5223. ; 141:1, s. 145-150
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Our objective was to evaluate the impact of vein graft harvesting technique on structure and function of vasa vasorum.Methods: Paired segments of great saphenous veins harvested either with conventional harvesting technique or no-touch technique were obtained from 9 consecutive patients undergoing coronary artery bypass grafting. Quantitative measurements, using immunohistochemistry and morphometry, were performed. Ultrastructural analyses of vasa vasorum were performed with electron microscopy. Video footage of superficial vasa vasorum in an implanted saphenous vein graft harvested with the no-touch technique was captured during a coronary bypass operation and is presented for online viewing.Results: The total area of vasa vasorum in vein grafts harvested with the conventional technique was significantly reduced both in the media (P¼.007) and in the adventitia (P¼.014) compared with vein grafts harvested with the no-touch technique. Ultrastructural findings indicated that the no-touch technique preserved an intact vasa vasorum whereas the conventional technique did not. Video footage showed retrograde flow in the vasa vasorum in vein graft harvested with the no-touch technique.Conclusions: These findings showthat the no-touch technique for saphenous vein graft harvesting for coronary bypass grafting preserves an intact vasa vasorum. This could represent one of the mechanisms underlying the improved patency of saphenous vein grafts harvested with this technique.
|
|
| 2. |
- Dreifaldt, Mats, et al.
(författare)
-
The No-Touch Saphenous Vein as the Preferred Second Conduit for Coronary Artery Bypass Grafting
- 2013
-
Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 96:1, s. 105-111
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Injury incurred while saphenous veins are being obtained results in poor graft patency and impairs the results of coronary artery bypass grafting. A novel method of obtaining veins, the no-touch technique, has shown improved long-term saphenous vein graft patency.Methods: This randomized trial included 108 patients undergoing coronary artery bypass grafting and compared the patency of no-touch saphenous vein with that of radial artery grafts. Each patient was assigned to receive one no-touch saphenous vein and one radial artery graft to either the left or the right coronary territory to complement the left internal thoracic artery.Results: Angiography was performed in 99 patients (92%) at a mean of 36 months postoperatively. Graft and grafted coronary artery patency was evaluated. The patency of grafts for no-touch saphenous vein and radial artery was 94% versus 82% (p = 0.01), respectively. The patency of coronary arteries grafted with no-touch saphenous vein and radial artery grafts was 95% versus 84% (p = 0.005), respectively. Eighty-nine of 96 (93%) left internal thoracic artery grafts were patent.Conclusions: No-touch saphenous vein grafts showed a significantly higher patency rate than the radial artery grafts and the patency was comparable to the patency for left internal thoracic artery grafts. This highlights the improvement in saphenous vein graft quality with the no-touch technique and increases the number of situations in which saphenous veins may be preferable to radial artery grafts as conduits in coronary artery bypass grafting.
|
|
| 3. |
- Dreifaldt, Mats, et al.
(författare)
-
The Vasa Vasorum and Associated Endothelial Nitric Oxide Synthase is More Important for Saphenous Vein Than Arterial Bypass Grafts
- 2013
-
Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 64:4, s. 293-299
-
Tidskriftsartikel (refereegranskat)abstract
- No-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasa vasorum is implicated in the success of NT harvesting. We compared the vasa vasorum and endothelial nitric oxide synthase (eNOS) in NT SV with ITA and radial artery (RA) grafts. Skeletonized SV (SSV) was also analyzed. The NT SV had a higher number and larger vasa vasorum compared with ITA (P = .0001) and RA (P = .0004) that correlated with eNOS protein. Activity of eNOS in SSV grafts was significantly lower than NT SV grafts (P = 004). Since a high proportion of the vasa vasorum are removed in SSV using the CT, we suggest that preservation of the vasa vasorum and eNOS-derived NO contributes to the high patency for NT as compared with SSV grafts.
|
|
| 4. |
- Johansson, Benny L., et al.
(författare)
-
No touch vein harvesting technique for CABG improves the long-term clinical outcome
- 2009
-
Ingår i: Scandinavian Cardiovascular Journal. - Stockholm : Scandinavian University Press. - 1401-7431 .- 1651-2006. ; 43:1, s. 63-68
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the long-term clinical outcome, averaging 8.5 years, of two saphenous vein harvesting techniques for CABG; no touch (NT) versus conventional (C). DESIGN: In a randomized study, 49/52 in group NT and 44/52 in group conventional were evaluated for reangina, myocardial infarction, new revascularization, functional class, risk factors and medical treatment. The vein grafts and the native coronary arteries were correlated to the occurrence of reangina. RESULTS: There were significantly more patients free from angina and in NYHA class I (67.3 versus 43.2%; p =0.02) in group NT compared to group C. No cardiac death was found in group NT versus three in group C. There were trends towards fewer patients with cardiac death or myocardial infarction (3.8 vs. 13.4%; p =0.16), more patients free from angina (75.5 vs. 63.6%; p =0.26) and fewer patients with graft occlusion (24.3 vs. 43.2% (p =0.14) in group NT. CONCLUSIONS: The results of the NT-technique are encouraging with no cardiac deaths, significantly more asymptomatic patients and a trend towards impact on hard clinical endpoints compared to the conventional technique.
|
|
| 5. |
- Johansson, Benny L., et al.
(författare)
-
Slower progression of atherosclerosis in vein grafts harvested with 'no touch' technique compared with conventional harvesting technique in coronary artery bypass grafting : an angiographic and intravascular ultrasound study
- 2010
-
Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 38:4, s. 414-419
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: In a long-term randomised coronary artery bypass grafting (CABG) study, the patency rate using a new 'no touch' (NT) vein-graft preparation technique was superior to the conventional (C) technique. This cineangiographic and intravascular ultrasound (IVUS) substudy examined possible mechanisms.Methods: A total of 45 patients (118 grafts) in the NT group and 46 patients (112 grafts) in the C group had patent grafts at short-term follow-up after 18 months. Thirty-seven patients (91 grafts) in the NT group and 37 patients (77 grafts) in the C group had patent grafts at long-term follow-up after 8 5 years, and were evaluated on a scale from 0 (normal) to 2 (significant stenosis) by cineangiogram. IVUS was performed in 15 NT grafts and 14 C grafts in the short-term follow-up, and 27 NT grafts and 26 C grafts in the long-term follow-up, in grafts considered normal by the cineangiogram. The grafts were evaluated with respect to lumen volume, intimal thickness, incidence of plaque and plaque components.Results: In the short-term follow-up, the cineangiogram showed more normal grafts (89.0% in the NT group compared with 75.0% in the C group), and the number of grafts with stenosis was 11.0% in the NT group compared with 25.0% in the C group (p = 0.006). IVUS showed less mean intimal thickness (0.43 (0.07) mm vs 0.52 (0.08) mm; p = 0.03), less grafts with considerable intimal hyperplasia (>= 0.9 mm; 20% vs 78.6%; p = 0.011) and fewer patients with considerable hyperplasia (>= 0.9 mm; 25% vs 100%; p = 0.007). In the long-term follow-up, the cineangiogram showed more normal grafts, with 91.2% in the NT group compared with 83.1% in the C group; there were fewer grafts with significant stenosis, with 7.7% in the NT group compared with 15 6% in the C group (p = 0.14). IVUS showed fewer grafts containing multiple plaques (14.8% vs 50%; p = 0.008), less advanced plaque with lipid (11.8% vs 63.9%; p = 0.0004) and less maximal plaque thickness (1.04 (0.23) mm vs 1.32 (0.25) mm; p = 0.02) in the NT group compared with the C group.Conclusion: The superior long-term patency rate using the NT vein-graft technique at CABG could be explained by a significantly slower progression of atherosclerosis. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
|
|
| 6. |
|
|
| 7. |
- Samano, Ninos, 1972-, et al.
(författare)
-
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
- 2015
-
Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Mosby-Elsevier. - 0022-5223 .- 1097-685X. ; 150:4, s. 880-888
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study investigates whether the no-touch (NT) vein graft, at a mean time of 16 years, maintains a significantly higher patency rate than conventional (C) vein grafts and still has patency comparable to that of the left internal thoracic artery (LITA).Methods: A total of 156 patients accepted for coronary artery bypass grafting were randomly allocated to 1 of 3 groups. In the C group, the saphenous vein (SV) was stripped and distended. In the intermediate group, the SV was stripped but not distended. In the NT group, the SV was neither stripped nor distended, but rather harvested with a fat pedicle. This study is an angiographic follow-up of the C and NT groups, at a mean time of 16 years postoperatively.Results: Fifty-four patients were included (C group = 27; NT group = 27). In all, 72 and 75 vein grafts were completed in groups C and NT, respectively. Crude SV graft patency was 64% in the C group versus 83% in the NT group (P = .03), which was similar to the patency of the LITA (88%). The harvesting technique had a major impact on the patency with a hazard ratio for occlusion of 1.83 for the C group (P = .04).Conclusions: Harvesting the SV with the NT technique conferred, at a mean time of 16 years, a significantly higher patency than the conventional technique that was still comparable to that of the LITA.
|
|
| 8. |
- Souza, Domingos S. R., et al.
(författare)
-
Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery : results of a randomized longitudinal trial
- 2006
-
Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 132:2, s. 373-U75
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure. A novel "no touch" technique provides high short- and long-term patency rates.Method: This randomized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery. Conventional: 52 patients had their veins stripped, distended, and stored in saline solution. No-touch: 52 patients had veins removed with surrounding tissue, not distended, and stored in heparinized blood. Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups.Results: The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups. The angiographic assessment at 18 months postoperatively showed 89% conventional versus 95% no-touch grafts were patent. Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76% and 90% for the no- touch group ( P =.01). The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting ( odds ratio = 3.7, P =.007) for the no- touch versus the conventional technique and the vein quality before implantation ( odds ratio = 3.2, P =.007) for veins that were of good quality. By comparison the patency of the thoracic artery grafts was 90%.Conclusion: Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery.
|
|
