SWEDEGRAFT Trial: No-Touch Vein Graft Harvesting Fails to Improve Patency in CABG
Key Insights
The SWEDEGRAFT trial found that no-touch saphenous vein graft (SVG) harvesting did not reduce graft failure compared to conventional open harvesting in CABG patients at 2 years.
No-touch SVG harvesting was associated with a significantly higher rate of wound complications compared to conventional harvesting (49.6% vs. 25.2%).
The study's findings do not support the routine use of the no-touch approach to SVG harvesting in patients undergoing isolated CABG.
The SWEDEGRAFT trial, presented at the European Society of Cardiology Congress, investigated whether no-touch (NT) saphenous vein graft (SVG) harvesting improves graft patency compared to conventional open skeletonized (COS) SVG harvesting in coronary artery bypass grafting (search) (CABG). The multicenter, registry-based, randomized trial found that NT harvesting did not result in less graft failure at 2 years but increased wound complications.
The trial enrolled 902 patients undergoing isolated CABG with at least one SVG. Patients were randomized to NT or COS SVG harvesting. The primary outcome, a composite of ≥50% SVG stenosis on 2-year coronary computed tomography angiography, ≥50% SVG stenosis on coronary angiography, or all-cause death, occurred in 19.8% of the NT group versus 24.0% of the COS group (difference -4.3%, 95% CI -10.1 to 1.6%, p = 0.15).
Secondary Outcomes
Secondary outcomes revealed that the composite of all-cause death, myocardial infarction (search), and repeat revascularization at 4.4 years occurred in 12.6% of the NT group versus 9.9% of the COS group (HR 1.30, 95% CI 0.87-1.93, p = 0.195). Notably, SVG harvest site wound complications at 2 years were significantly higher in the NT group (49.6%) compared to the COS group (25.2%), with a difference of 24.4% (95% CI 17.7-31.1%).
The rationale behind the NT technique is to minimize mechanical distension and trauma by preserving the adventitia and vasa vasorum of the conduit before implantation. While early clinical data suggested promising NT graft patency rates, these studies had limited sample sizes and generalizability. The SWEDEGRAFT trial is the second large multicenter trial to compare NT to COS harvesting.
Implications and Comparisons
The SWEDEGRAFT findings contrast with the Chinese PATENCY trial, which reported better graft patency at 3 and 12 months with the NT technique. These discrepancies may be due to the longer follow-up in SWEDEGRAFT or differences in patient populations, harvesting techniques, or event adjudication. Both trials, however, showed a higher incidence of wound complications with NT harvesting. According to Dr. Stefan James, who presented the findings at the European Society of Cardiology Congress, these results do not support the routine use of the NT approach to SVG harvesting in isolated CABG patients. The study also does not compare the open NT technique with the more common endoscopic SVG harvesting.