No-touch versus conventional vein harvesting in coronary bypass surgery: A meta-analysis of randomized controlled trials

<h2>Abstract</h2><h3>Objectives</h3> The study evaluated whether no-touch saphenous vein harvesting (NTH) improves graft patency compared with conventional harvesting (CH) and whether this translates into clinical benefit in coronary artery bypass grafting. <h3>Methods</h3> A systematic literature review was performed during May 2025 to retrieve randomized controlled trials comparing NTH and CH in coronary artery bypass grafting. Primary outcomes included graft occlusion per graft and per patient, and graft failure per patient. Secondary outcomes included all-cause death, myocardial infarction, repeat revascularization, recurrent angina, and leg wound complications. Data were extracted and pooled analyses were performed using a random-effects model. <h3>Results</h3> Ten randomized controlled trials with 4251 patients (NTH: 2143, CH: 2108) and 4848 grafts (NTH: 2415, CH: 2433) were included. Weighted mean follow-up was 39.0 months (range, 0.2-192 months). NTH was associated with a lower risk of graft occlusion per graft (risk ratio [RR], 0.70; 95% CI, 0.61-0.81), per patient (RR, 0.71; 95% CI, 0.60-0.84), and graft failure per patient (RR, 0.74; 95% CI, 0.64-0.87). Secondary outcomes showed no significant differences in all-cause death (hazard ratio [HR], 0.87; 95% CI, 0.43-1.79), myocardial infarction (HR, 0.79; 95% CI, 0.34-1.87), repeat revascularization (HR, 0.80; 95% CI, 0.32-1.95), and recurrent angina (HR, 0.59; 95% CI, 0.11-3.33), except for leg wound complications, which were significantly higher with NTH (RR, 1.78; 95% CI, 1.30-2.43). <h3>Conclusions</h3> NTH significantly improves graft patency compared with CH but confers no midterm advantage in major clinical outcomes, with increased leg wound complications. Large-scale studies with extended follow-up are needed to define its clinical influence.