Abstract 4371590: No-Touch Saphenous Vein Grafting Reduce Occlusion Risk but Increase Leg Wound Complications in Coronary Artery Bypass Grafts: A Meta-Analysis

Introduction: Saphenous vein graft (SVG) failure remains a key limitation in coronary artery bypass grafting (CABG). The no-touch harvesting technique aims to improve graft durability by preserving perivascular tissue and preventing endothelial injury caused by mechanical trauma during conventional harvesting. Purpose: To assess whether the no-touch SVG harvesting technique offers superior graft patency and acceptable safety outcomes compared to conventional SVG harvesting in patients undergoing CABG. Methods: A systematic search was conducted in PubMed, Cochrane CENTRAL, Ovid Medline, and Web of Science databases through May 5, 2025. Randomized controlled trials (RCTs) comparing no-touch versus conventional SVG harvesting in CABG were included. The primary outcome was SVG occlusion per graft at the end of follow-up. Secondary outcomes included SVG occlusion per patient, all-cause mortality, total surgery time, and wound complications. Data were pooled using an inverse variance–weighted random-effects model. Analyses were conducted using the “meta” package in R (version 4.4.3). Results: Eight RCTs comprising 4,234 patients (mean age: 62.6 ± 8.5 years) were included. No-touch SVGs were associated with significantly decreased risk of SVG occlusion by 31% compared to conventional SVGs (RR: 0.69; 95% CI: 0.60–0.80; I2 = 0%, p < 0.0001). A similar benefit was observed at the patient level (RR: 0.68; 95% CI: 0.56–0.83; I2 = 0%, p = 0.0002). All-cause mortality was comparable among the techniques (RR: 1.04; 95% CI: 0.63–1.71; I2 = 0%, p = 0.88). The no-touch technique was associated with a statistically significant but clinically negligible increase in operative time (MD: 9.69 minutes; 95% CI: 2.48–16.90; I2 = 62%, p = 0.0084). However, wound complications occurred more frequently in the no-touch group (RR: 2.03; 95% CI: 1.67–2.47; I2 = 0%, p < 0.0001). Conclusion: The no-touch SVG harvesting technique provides superior graft patency at both the graft and patient levels compared to conventional methods. Although associated with a modest prolongation in operative time and a higher risk of wound complications, these drawbacks may acceptable in patients with low risk for wound morbidity and can potentially be improved upon by increased operator experience with this technique.