New Vein-Harvesting Technique Shows Promise in Reducing Bypass Graft Failure
Minimally Invasive No-Touch Technique Preserves Vein Health and May Improve Long-term Outcomes After Coronary Artery Bypass Surgery, According to New Study
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Vein graft failure remains a major challenge in coronary artery bypass surgery, with nearly one in four grafts failing within the first 12 to 18 months, often due to injury sustained during vein harvesting. Now, as reported in JTCVS Open, a new vein-harvesting approach known as Minimally Invasive No-Touch (MINT), developed by John Gallagher, M.D., a vascular surgeon in private practice in New York City and affiliated with the Montreal Heart Institute Research Centre, and tested in the laboratory of Victor Garcia, Ph.D. ’15, associate professor of pharmacology at New York Medical College, shows promising evidence of preserving vein health and improving graft durability.
“While coronary artery bypass surgery has improved significantly over time, we now recognize that much of the failure of saphenous vein grafts is driven by injury that occurs at the time the vein is harvested, setting off inflammation, thrombosis, and progressive narrowing of the graft, which ultimately fails over time,” says Dr. Garcia. “While endoscopic vein harvesting has significantly reduced postoperative wound complications and improved recovery, it has also introduced previously unrecognized sources of vascular trauma.”
Recognizing this gap, the researchers sought to develop and evaluate a technique that protects the vein’s functional integrity without sacrificing the advantages of minimally invasive surgery. MINT uses controlled hydrodissection, rather than blunt mechanical dissection, allowing the vein to be harvested with far less trauma while preserving both its structure and biologic function.
When Dr. Garcia’s lab examined the MINT-harvested veins under high-resolution scanning electron microscopy, those harvested with the MINT procedure maintained an intact, healthy endothelial surface, in contrast to the disrupted architecture seen when using a standard endoscopic vein harvesting procedure.
“We expected that reducing mechanical trauma would help protect the blood vessel’s lining, but the size of the effect was striking,” says Dr. Garcia. “What surprised us most was that standard endoscopic harvesting, despite being less invasive for patients, caused more damage to the vessel lining than even traditional open no-touch approaches. MINT also outperformed both existing techniques in preserving biological function, underscoring that protecting the vessel itself is just as important as minimizing incision size.”
Because MINT is reproducible and compatible with modern minimally invasive surgical practices, it could be widely adopted with minimal additional training, notes Dr. Garcia. Once validated in larger clinical trials, the technique has the potential to significantly improve long-term outcomes for patients undergoing bypass surgery.
Dr. Garcia also emphasized the collaborative effort behind the work, crediting an international team of experts whose contributions were essential to the study’s success. These include Dr. Gallagher, the inventor of the MINT technique; Daniel Fusco, M.D., of the Department of Surgery at St. Vincent’s Hospital in Connecticut; and leading figures in cardiac surgery worldwide, including Louis Perrault, M.D., Ph.D., of the Montreal Heart Institute Research Centre at Université de Montréal, and Maximilian Emmert, M.D., Ph.D., of the Department of Cardiothoracic and Vascular Surgery at Deutsches Herzzentrum der Charité in Germany. “This work reflects New York Medical College’s longstanding commitment—particularly within the Department of Pharmacology—to advancing innovative, clinically impactful cardiovascular research,” says Dr. Garcia.
