Background:Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare.Methods:From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient.Results:During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41–0.80]; P<0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41–0.76]; P<0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35–0.85]; P<0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85–3.52]; P<0.001).Conclusions:Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03126409.

中文翻译：

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冠状动脉旁路移植术后 12 个月的无接触与传统静脉采集技术：多中心随机对照试验

背景：静脉移植物闭塞被认为是冠状动脉旁路移植术的主要挑战。先前的研究表明，与传统方法相比，静脉移植物采集的非接触技术可以降低闭塞率；然而，关于无接触技术的临床益处和普遍性的证据尚缺乏。方法：从 2017 年 4 月至 2019 年 6 月，我们以 1:1 的比例随机分配在 7 家医院接受冠状动脉旁路移植术的 2655 名患者接受无接触技术。触摸技术或传统的静脉采集方法。主要结果是 3 个月时计算机断层扫描血管造影显示的静脉移植物闭塞，次要结果包括 12 个月的静脉移植物闭塞、心绞痛复发和主要不良心脑血管事件。广义估计方程模型用于解释来自同一患者的移植物的集群效应。结果：在随访期间，2533（96.0%）名参与者在冠状动脉旁路移植术后 3 个月接受了 CT 血管造影，2434 名（92.2 %) 在 12 个月时收到。在 3 个月时，非接触组的静脉移植物闭塞率均显着低于常规组（2.8% 对 4.8%；优势比，0.57 [95% CI，0.41-0.80]；8%；优势比，0.57 [95% CI，0.41–0.80]；8%；优势比，0.57 [95% CI，0.41–0.80]；P <0.001）和 12 个月（3.7% 对 6.5%；优势比，0.56 [95% CI，0.41–0.76]；P <0.001）。在 12 个月时，非接触组的心绞痛复发率也较低（2.3% 对 4.1%；优势比，0.55 [95% CI，0.35-0.85]；P <0.01）。2组主要不良心脑血管事件发生率无显着差异。在 3 个月的随访中，无接触技术与较高的腿部伤口手术干预率相关（10.3% 对 4.3%；优势比，2.55 [95% CI，1.85-3.52]；P<0.001)。结论：与冠状动脉旁路移植术中的传统静脉采集方法相比，无接触技术显着降低了静脉移植物闭塞的风险并改善了患者预后。注册：网址：https://www.clinicaltrials.gov ; 唯一标识符：NCT03126409。