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. 2025 Feb 21:24:185-205.
doi: 10.1016/j.xjon.2025.02.007. eCollection 2025 Apr.

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

Mimi X Deng  1 , Zhenyu Li  2   3 , Dominique Vervoort  1   3   4 , Rebecca N Evan  5 , Stephen E Fremes  1   3   4
Affiliations

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

Mimi X Deng et al. JTCVS Open. .

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.

Keywords: cardiac surgery; coronary artery bypass grafting; graft patency; no-touch technique; randomized clinical trial; saphenous vein.

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Conflict of interest statement

Drs Deng and Vervoort are supported in part by the Canadian Institutes of Health Research Vanier Canada Graduate Scholarship. Zhenyu Li is supported by the Sunnybrook Research Institute Summer Scholarship. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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No-touch vein harvest is associated with less graft occlusion and more wound complications.
Figure 1
Figure 1
Forest plot for the comparison of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts for graft-level graft occlusion (A) and patient-level graft occlusion (B). TE, Estimate of treatment effect (ie, log risk ratio); seTE, standard error of treatment estimate; RR, risk ratio; CI, confidence interval.
Figure 2
Figure 2
Forest plot for the comparison of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts for all-cause mortality (A) and leg wound complications (B). TE, Estimate of treatment effect (ie, log risk ratio); seTE, standard error of treatment estimate; RR, risk ratio; CI, confidence interval.
Figure E1
Figure E1
Flow diagram outlining the study selection process, as formatted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Figure E2
Figure E2
Sensitivity analyses for studies using computed tomography angiography (CTA) exclusively for postoperative graft assessment. Graft-level (A) and patient-level (B) occlusion of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts. TE, Estimate of treatment effect (ie, log risk ratio); seTE, standard error of treatment estimate; RR, risk ratio; CI, confidence interval.
Figure E3
Figure E3
Leave-one-out analysis (LOO) for graft-level (A) and patient-level (B) occlusion of no-touch (NT) versus conventionally-harvested (CON) saphenous vein grafts. RR, Risk ratio; CI, confidence interval.
Figure E4
Figure E4
Forest plot for the comparison of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts for graft-level graft failure (A) and patient-level graft failure (B). TE, Estimate of treatment effect (ie, log risk ratio); seTE, standard error of treatment estimate; RR, risk ratio; CI, confidence interval.
Figure E5
Figure E5
Forest plot for the comparison of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts using Bayesian meta-analysis for graft-level occlusion (A), patient-level occlusion (B), all-cause mortality (C), and leg complications (D). The blue dot represents the mean posterior distribution of the log-transformed risk ratio for each study, with the black line showing the 95% credible interval. The black lines represent the mean and 95% credible interval of the pooled effect, respectively.
Figure E5
Figure E5
Forest plot for the comparison of no-touch (NT) versus conventionally harvested (CON) saphenous vein grafts using Bayesian meta-analysis for graft-level occlusion (A), patient-level occlusion (B), all-cause mortality (C), and leg complications (D). The blue dot represents the mean posterior distribution of the log-transformed risk ratio for each study, with the black line showing the 95% credible interval. The black lines represent the mean and 95% credible interval of the pooled effect, respectively.
Figure E6
Figure E6
Assessment of risk of bias using the Cochrane Collaboration's tool for assessing risk of bias.
Figure E7
Figure E7
Funnel plot for the primary outcome of graft occlusion.
See this image and copyright information in PMC

References

    1. McNeely C., Markwell S., Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 Medicare population. Ann Thorac Surg. 2016;102(1):132–138. doi: 10.1016/j.athoracsur.2016.01.016. - DOI - PubMed
    1. Goldman S., Zadina K., Moritz T., et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004;44(11):2149–2156. doi: 10.1016/j.jacc.2004.08.064. - DOI - PubMed
    1. Souza D. A new no-touch preparation technique. Technical notes. Scand J Thorac Cardiovasc Surg. 1996;30(1):41–44. doi: 10.3109/14017439609107239. - DOI - PubMed
    1. Souza D.S., Christofferson R.H., Bomfim V., Filbey D. “No-touch” technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium. Scand Cardiovasc J. 1999;33(6):323–329. doi: 10.1080/14017439950141362. - DOI - PubMed
    1. Tsui J.C.S., Souza D.S.R., Filbey D., Karlsson M.G., Dashwood M.R. Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel “no-touch” technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg. 2002;35(2):356–362. doi: 10.1067/mva.2002.121072. - DOI - PubMed

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