Graft patency of no-touch versus conventionally harvested saphenous vein conduits in coronary artery bypass grafting: A frequentist and Bayesian meta-analysis of randomized trials

Abstract

Background

No-touch (NT) saphenous vein harvest is a technique that minimizes intimal injury and has been shown to improve patency. This study aimed to directly compare NT saphenous vein grafts (SVGs) to conventional skeletonized (CON) SVGs through a meta-analysis.

Methods

A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency of NT-SVG and CON-SVG. The primary outcome was graft occlusion as a proportion of the total grafts assessed. Secondary outcomes were graft occlusion per patient, all-cause mortality, and leg wound complications. A random-effects model using a frequentist approach and Bayesian analysis were performed.

Results

A total of 235 studies were retrieved, of which 7 ultimately were chosen for analysis, with a total of 3334 randomized patients and 5798 SVGs. The pooled estimated age was 63.5 and 62.8 years for NT and CON, respectively, with approximately 14% of patients being women. The weighted mean angiographic follow-up was 11.6 months. Relative to CON-SVG, NT-SVG was associated with lower rates of graft occlusion per graft (relative risk [RR], 0.57; 95% confidence interval [CI], 0.46-0.72; P < .001) and per patient (RR, 0.61; 95% CI, 0.46–0.79; P < .001), comparable all-cause mortality (RR, 1.12; 95% CI, 0.56-2.25; P = .75), and a higher rate of leg wound complications (RR, 2.32; 95% CI, 1.78-3.02; P < .001). Findings for occlusion per graft were consistent with Bayesian analysis (RR, 0.57; 95% credible interval, 0.41-0.79).

Conclusions

Compared to CON, NT confers significantly better patency and equivalent survival but poorer harvest site healing. The clinical benefit of NT remains uncertain, and further evidence is needed.