Long-term clinical outcomes and morphology of no-touch saphenous vein grafts

Coronary artery bypass grafting with a saphenous vein graft is standard treatment for coronary artery disease. The no-touch harvesting technique has shown promise in improving the durability of saphenous vein grafts. This study aimed to investigate the clinical outcomes and morphology of no-touch harvested saphenous vein grafts compared with the conventionally harvested saphenous vein grafts.

Between January 2010 and December 2023, 979 patients underwent primary coronary artery bypass grafting for coronary artery disease using no-touch (n = 293) or conventionally harvested saphenous vein grafts (n = 689). Propensity score matching yielded 269 well-matched pairs. The long-term clinical outcomes were compared. We measured the saphenous vein graft diameter and perimeter using computed tomography in the postoperative periods within 1 month and beyond 6 months after surgery and calculated the graft-to-native ratio defined as the saphenous vein graft diameter divided by the coronary artery diameter, the mean adjacent difference defined as the average difference between adjacent 1-mm slices, and the coefficient of variation defined as the SD divided by their mean.

In the matched groups, 5-year survival (89.8% vs 79.5%, P < .001) and freedom from major adverse cardiovascular and cerebrovascular events (85.1% vs 74.7%, P = .014) and saphenous vein graft-related events (84.8% vs 64.8%, P < .001) favored the no-touch group than in the conventionally harvested saphenous vein grafts group. Beyond 3-year follow-up, the no-touch group showed fewer large graft-to-native ratio (≥3.2) grafts and lower mean adjacent difference and coefficient of variation, indicating less oversized grafts and smoother luminal surfaces.

In the long term, no-touch saphenous vein grafts improve clinical outcomes, provide appropriate graft diameter for coronary arteries, and maintain luminal integrity.