No-touch saphenous vein grafts in coronary artery surgery (SWEDEGRAFT): Rationale and design of a multicenter, prospective, registry-based randomized clinical trial.

The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVGs) harvested with the "no-touch" technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique. This article describes the rationale and design of the randomized trial and baseline characteristics of the population enrolled during the first 9 months of enrollment. The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated nonemergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients. The primary end point is the proportion of patients with graft failure defined as SVGs occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, earlier clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within 2 years. High-quality health registries and coronary computed tomography angiography are used to assess the primary end point. The secondary end points include wound healing in the vein graft sites and the composite outcome of major adverse cardiac events during the first 2 years based on registry data. Demographics of the first 200 patients enrolled in the trial and other CABG patients operated in Sweden during the same time period are comparable when the exclusion criteria are taken into consideration. RCT# NCT03501303.

Saphenous vein grafts in contemporary coronary artery bypass graft surgery.

Myocardial ischaemia resulting from obstructive coronary artery disease is a major cause of morbidity and mortality in the developed world. Coronary artery bypass graft (CABG) surgery is the gold-standard treatment in many patients with complex multivessel coronary artery disease or left main disease. Despite substantial improvements in the outcome of patients undergoing CABG surgery in the past decade, graft patency remains the 'Achilles' heel' of this procedure. Whereas the use of the left internal mammary artery as a conduit is associated with the highest 10-year patency rate (>90%), saphenous vein grafts - the most commonly used conduit in CABG surgery - fail in 40-50% of treated patients by 10 years after surgery. Vein graft disease (VGD) and failure result from complex pathophysiological processes that can lead to complete occlusion of the graft, affecting long-term clinical outcomes. Optimal harvesting techniques, intraoperative preservation strategies and intraoperative patency control have important roles in the prevention of VGD. In addition, several studies published in the past decade have reported similar mid-term patency rates between vein grafts and arterial grafts when veins are used as a composite graft based on the internal mammary artery. In this Review, we present the latest evidence on the utilization of saphenous vein grafts for CABG surgery and provide an overview of the current practices for the prevention of VGD and vein graft failure.

SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449).

BACKGROUND: Single centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG). METHODS: Adults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results. RESULTS: Two hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p = 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%), p = 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%, p < 0.01). Including this study's results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29-0.82, p = 0.007 in 3 randomized and 1 observational study at 1 year postoperatively. CONCLUSIONS: The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting. TRIAL REGISTRATION: NCT01047449 .

Saphenous vein: advances.

Although the saphenous vein (SV) is a widely used conduit for coronary artery bypass graft surgery (CABG), lower long-term graft patency rates and worse clinical outcomes have been reported after CABG performed with SV grafts compared with CABG performed with internal thoracic artery (ITA) grafts. Of various efforts to overcome the limitations of SV that are resulting from structural and functional differences from arterial conduit, recent improvement in harvesting techniques including no-touch technique, surgical strategy of using the SV as part of a composite graft over an aortocoronary bypass graft, and external stenting of the SV will be discussed in this topic.

Medidas comportamentais de presença em ambientes virtuais / Behavioral measures of presence in virtual environments / Medidas conductuales de presencia en entornos virtuales

Para identificar e analisar as funções de respostas de interação com os estímulos de um ambiente virtual e suas relações com o grau de senso de presença relatado, utilizou-se o Xbox 360® com o jogo Kinect Adventures. Foram executadas quatro fases do jogo e feita aplicação de um questionário. As respostas verbais dirigidas aos estímulos virtuais não apresentaram um padrão comportamental, mas a frequência de respostas não verbais direcionadas a estímulos virtuais (RNV-EV) e o senso de presença aumentaram com o avanço nos estágios. Sugere-se que a frequência de RNV-EV é uma medida complementar apropriada do senso de presença e que fazer análises funcionais dos comportamentos emitidos durante a imersão pode ser uma forma útil de acessar o senso de presença.

To identify and analyze the functions of interactions responses to the stimuli of a virtual environment and their relation to the degree of reported presence of sense, the Xbox 360® with the Kinect Adventures game was used. Four phases of the game were executed and a questionnaire was administered. Verbal responses directed to virtual stimuli did not show a behavioral pattern, but the frequency of non-verbal responses directed to virtual stimuli (NVS-VS) and the sense of presence increased with the advance in stages. It is suggested that the frequency of VR-VS is an appropriate complementary measure of the sense of presence and perform functional analyzes of behavior during immersion can be useful to access the sense of presence.

Para identificar y analizar las funciones de las respuestas de interacción a los estímulos de un ambiente virtual y su relación con el grado de presencia relatado, se utilizó el Xbox 360® con el juego Kinect Adventures. Se llevaron a cabo cuatro fases del juego y un cuestionario. Las respuestas verbales dirigidas a los estímulos virtuales no mostraron un patrón de conducta, pero la frecuencia de respuestas no verbales dirigidas a los estímulos virtuales (RNV-EV) y la presencia aumentaron con el avance en etapas. Se sugiere que la frecuencia de RNV-EV es una medida complementaria apropiada de la presencia y que hacer análisis funcional de la conducta emitida durante la inmersión puede ser una forma útil para acceder al sentido de presencia.