No-touch technique for saphenous vein graft harvesting in coronary artery bypass surgery safely improves graft patency: a meta-analysis of randomized controlled trials.

Abstract

Objective: The no-touch (NT) technique for saphenous vein graft (SVG) harvesting has been gaining popularity as several trials have shown its superiority in maintaining graft patency. However, this technique's clinical outcome and safety are still disputed and the results vary widely. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the effectiveness and safety of this method.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were conducted for this systematic review and meta-analysis. A comprehensive search of the literature was carried out with Embase, Scopus, and PubMed databases. The articles underwent extensive evaluation and analysis.

Results: Six RCTs comparing the NT and conventional (CON) techniques were included. Primary outcomes were measured using graft occlusion. Graft failure rates and clinical outcomes including major adverse cardiac and cerebrovascular events (MACCE), all-cause death, myocardial infarction, repeat revascularization, and leg wound complications were evaluated as secondary outcomes. The NT technique significantly decreased graft occlusion (risk ratio (RR) = 0.58; 95% confidence interval (CI) = 0.46 to 0.72; p < 0.001) and failure (RR = 0.65; 95% CI = 0.54 to 0.77; p < 0.001). Safety analysis also showed no significant risk difference for clinical outcomes, and although significantly higher, leg complications in the NT technique are minor and avoidable.

Conclusion: The NT technique increases long-term graft patency with no significant risk difference for clinical outcomes compared to the CON technique. However, the leg wound complications are significantly higher in the NT technique compared to the CON technique.

Graphical abstract: