A Clinical Trial on No-touch Vein Graft (NT-graft) in Coronary Surgery

Ischemic Heart Disease Clinical Trial

— SWEDEGRAFT  

Official title:

A Nordic, Multicentre, Prospective, Randomized, Register Based, Clinical Trial on No-touch Vein Graft (NT-graft) in Coronary Surgery

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03501303
• Other study ID #: U-2015-477
• Status: Active, not recruiting
• Phase: N/A
• Start date: April 20, 2018
• Est. completion date: September 30, 2024

Study information

• Verified date: June 2024
• Source: Uppsala University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective in this study is to investigate if vein grafts harvested and implanted with the non-touch technique are superior to conventional vein graft technique with respect to mid-term patency, in patients undergoing CABG surgery.

Description:

Coronary artery bypass grafting (CABG) is the most common surgical procedure aimed against ischemic heart disease (IHD) in Sweden. Early and late success of CABG is the result of sustained patency of the bypass grafts. The choice of conduit (graft) for CABG has been shown to impact graft patency. The excellent early and late patency of in situ left internal thoracic artery (LITA) has stimulated the use of other arterial grafts, such as the radial artery (RA) and the right internal thoracic artery (RITA). However, target coronary vessels/lesions are limitations for the use of RITA and RA, and concerns regarding postoperative sternal wound infection with increases of early morbidity and mortality are reasons for limited use of bilateral ITA. The saphenous vein grafts (SVG), together with the left internal thoracic artery, are still the most commonly used conduits in CABG surgery.

Vein graft failure is associated with recurrence of angina and one of the primary reasons for reintervention, either by redo CABG or percutaneous coronary intervention (PCI). Early vein graft failure is not uncommon, and it was shown in the PREVENT IV multi-center trial6, that vein graft failure (occluded or stenosed) had occurred in 27% of all vein grafts at one year.

Despite this, SVG remains as an important conduit for most patients in contemporary bypass surgery and every effort should focus on promoting short and long-term patency of SVG. Previous studies by Souza have demonstrated that harvesting the SVG with a pedicle of surrounding tissue and without vein graft distension, the so-called "No touch" technique (NT), significantly improve patency compared with conventional technique i.e. stripping the vein of all adventitial tissue and distension prior to implantation. An international multi center randomized controlled clinical trial, (SUPERIOR SVG, NCT01047449) including 12 centers and 250 patients, was recently presented and showed favorable but not significant results for No touch vein grafts compared to conventional vein grafts. The protocol did not include cardiac computed tomography angiography (CCTA) for every patient which is an important difference compared to our planned study.

The major limitation regarding the putative benefit of NT technique of vein harvesting is that most of the data has all been derived from a single center. The surgical vein graft harvesting technique for NT grafts is more demanding. Therefore, there is a clear clinical equipoise to perform a multi-center randomized clinical trial to validate the excellent single-center results and determine whether the NT technique is reproducible, feasible and generalizable.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 902
• Est. completion date: September 30, 2024
• Est. primary completion date: January 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 80 Years

Eligibility

Inclusion Criteria:

• first time CABG patients

• age up to 80 years at the time for inclusion

• need for at least one vein graft

• able to provide informed consent and accepted for isolated primary non-emergent CABG.

Exclusion Criteria:

• unable to use greater saphenous vein grafts (SVG) due to previous vein stripping or poor vein quality

• allergy to contrast dye

• renal failure with glomerular filtration rate (GFR)<15 ml/min

• coagulation disorders

• excessive risk of wound infection

• participation in other interventional trial on grafts

• any condition that seriously increases the risk of non-compliance or loss of follow-up

Related Conditions & MeSH terms

• Coronary Artery Disease
• Heart Diseases
• Ischemic Heart Disease
• Myocardial Ischemia

Intervention

Procedure:
• No touch technique
Veins for CABG is harvested with the no touch technique
• Control technique
Veins for CABG is harvested with the Control technique.

Locations

Country	Name	City	State
Denmark	Aarhus	Aarhus
Sweden	Göteborg	Göteborg
Sweden	Karlskrona	Karlskrona
Sweden	Linköping	Linköping
Sweden	Lund	Lund
Sweden	Örebro, Sweden	Örebro
Sweden	Karolinska Sjukhuset	Stockholm
Sweden	Umeå	Umeå
Sweden	Uppsala	Uppsala

Sponsors (1)

Lead Sponsor	Collaborator
Uppsala University

Countries where clinical trial is conducted

Denmark,  Sweden, 

References & Publications (11)

Alexander JH, Hafley G, Harrington RA, Peterson ED, Ferguson TB Jr, Lorenz TJ, Goyal A, Gibson M, Mack MJ, Gennevois D, Califf RM, Kouchoukos NT; PREVENT IV Investigators. Efficacy and safety of edifoligide, an E2F transcription factor decoy, for preventi — View Citation

Dashwood MR, Savage K, Dooley A, Shi-Wen X, Abraham DJ, Souza DS. Effect of vein graft harvesting on endothelial nitric oxide synthase and nitric oxide production. Ann Thorac Surg. 2005 Sep;80(3):939-44. doi: 10.1016/j.athoracsur.2005.03.042. — View Citation

Dashwood MR, Savage K, Tsui JC, Dooley A, Shaw SG, Fernandez Alfonso MS, Bodin L, Souza DS. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthas — View Citation

Desai ND, Cohen EA, Naylor CD, Fremes SE; Radial Artery Patency Study Investigators. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med. 2004 Nov 25;351(22):2302-9. doi: 10.1056/NEJMoa040982. — View Citation

Guru V, Fremes SE, Tu JV. How many arterial grafts are enough? A population-based study of midterm outcomes. J Thorac Cardiovasc Surg. 2006 May;131(5):1021-8. doi: 10.1016/j.jtcvs.2005.09.036. Epub 2006 Apr 25. — View Citation

Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986 Jan 2;314(1):1-6. doi — View Citation

Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, Cosgrove DM. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999 May;117(5):855-72. doi: 10.1016/S0022-5223(99)70365-X. — View Citation

Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg. 1996 Jun;111(6):1200-7. doi: 10.1016/s0022-5223(96)70222-2. — View Citation

Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. 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. J Thorac Cardiovasc Surg. 20 — View Citation

Souza DS, Dashwood MR, Tsui JC, Filbey D, Bodin L, Johansson B, Borowiec J. Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques. Ann Thorac Surg. 2002 Apr;73(4):1189-95. doi: 1 — View Citation

Souza DS, Johansson B, Bojo L, Karlsson R, Geijer H, Filbey D, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a ra — View Citation

* Note: There are 11 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Questions about wound healing	The questionnaires will be assessed by Telephone.	At 3 months and 2 years after CABG surgery.
Other	Questions about Quality of Life	The patients will be interviewed about problems with angina (SAQ-7, Seattle Angina Questionnaire-7). The questionnaire will be assessed by telephone.	At 2 years after CABG surgery.
Primary	Saphenous vein grafts (SVGs) occluded/stenosed	The proportion of patients with graft failure defined as: SVGs occluded/stenosed >50% on CCTA or has undergone percutaneous intervention to a vein graft or died within two years after CABG.	Follow up period is from inclusion and surgery up to two years after.
Secondary	Major adverse cardiac events (MACE) 1	The frequency of incidence of all cause death	Follow up period is from inclusion and surgery up to two years after.
Secondary	MACE 2	The frequency of myocardial infarction	Follow up period is from inclusion and surgery up to two years after.
Secondary	MACE 3	The frequency of repeated revascularization	Follow up period is from inclusion and surgery up to two years after.
Secondary	Wound complications	The frequency of incidence of postoperative leg wound complications from the harvesting site.	Follow up period is from inclusion and surgery up to two years after.
Secondary	Vein-graft stenosis	The frequency of non-significant vein graft stenosis (20-50%)	Follow up period is from inclusion and surgery up to two years after.