Increased patency with comparable mortality and revascularization risk:
Is the case for no-touch vein harvesting open and shut?
Abstract
Since the introduction of the saphenous vein graft (SVG) for coronary
artery bypass grafting (CABG) in 19621, the SVG has remained the most
commonly used conduit to the non-LAD territories for more than half a
century. However, several issues surrounding the use of SVGs, including
higher graft occlusion rates and wound complications from the harvesting
process, have been identified in clinical practice. As such, significant
interest has been dedicated towards developing harvesting techniques
that minimize the risk of these acute and late complications. In this
issue of the Journal of Cardiac Surgery, Yokoyama and colleagues
compared the impact of open vein harvesting (OVH), endoscopic vein
harvesting (EVH) and no-touch vein harvesting (NT) on all-cause
mortality, revascularization and graft failure, using a network
meta-analysis based on randomized controlled trials and propensity-score
matched studies. The results showed that the risk of graft failure was
approximately halved amongst patients receiving NT compared with EVH and
OVH; importantly, though, NT was not associated with lower all-cause
mortality or revascularization risk. To further examine whether the use
of NT grafts endow patients with better long-term clinical outcomes,
such as mortality, myocardial infarction, and revascularization rates, a
large-scaled randomized controlled trial or a patient-level combined
meta-analysis is required.