Case Series Analysis of No-Touch Graft Configurations in Coronary Artery Bypass Grafting: Comparative Outcomes

Introduction. This study aims to evaluate the outcomes of three distinct configurations of No-Touch (NT) grafts used in coronary artery bypass grafting, focusing on the safety and efficacy of these techniques. Methods. Nine cases were analysed and categorized into three groups: Coronaro-Coronary NT Left Internal Thoracic Artery (LITA) non-aortic composite grafts; NT-LITA 'Y' composite grafts, and a Posterior Descending-Obtuse Marginal-Aorta NT vein graft. Results. In Group 1, no traditional proximal anastomosis was performed. The NT vein graft was distally anastomosed to the obtuse marginal branch in an end-to-side manner, followed by side-to-side anastomosis to the Ramus Intermedius (RI) or Diagonal, and a final end-to-side connection to the Ramus Interventricularis Anterior (RIA). In Group 2, where NT-LITA 'Y' composite grafts were utilized, the first graft was placed end-to-side and the second side-to-side, addressing either two marginal branches or the OM and RI branches. Proximal anastomoses were occasionally performed to the LITA or aorta. In Group 3, a sequential anastomosis was conducted, with the NT vein graft connected from the right posterior descending artery in an end-to-side manner, followed by a side-to-side connection to the OM branch. Patients had patent No-Touch vein grafts on their follow-up MSCT, without any post-surgery complications, except 2 cases where one had occluded marginal branches, and one LITA-RIA anastomosis. Conclusions. Different No-Touch graft configurations demonstrate high patency rates and a favorable safety profile. Overall, graft patency was preserved in most patients during follow-up, although several anastomotic occlusions were observed. These findings suggest NT grafts are a viable alternative to traditional methods, warranting further research into long-term outcomes and surgical refinements.