Graft patency of no-touch versus conventionally harvested saphenous vein conduits in coronary artery bypass grafting: A frequentist and Bayesian meta-analysis of randomized trialsCentral MessagePerspective
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...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-04-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273625000555 |
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| Summary: | 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. |
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| ISSN: | 2666-2736 |