Outcomes of no-touch vs conventionally harvested saphenous veins for coronary artery bypass surgery: A meta-analysis of randomized trials

Abstract OBJECTIVES The no-touch (NT) technique for saphenous vein (SV) harvesting in coronary artery bypass surgery preserves perivascular tissue and has been proposed to improve vein graft patency compared to conventional (CON) harvesting. However, recent large randomized clinical trials (RCTs) have reported conflicting results. We performed a meta-analysis of all available RCTs comparing graft patency and clinical outcomes between NT-SV and CON-SV harvesting techniques. METHODS A systematic review was conducted through May 9, 2025 to identify RCTs with systematic imaging follow-up comparing the NT-SV and CON-SV. The primary outcome was graft failure. Secondary outcomes included mortality, major adverse cardiac events (MACE; composite of mortality, myocardial infarction, or repeat revascularization), and leg wound complications. Outcomes were pooled using inverse variance random and fixed effects models. RESULTS Eight RCTs involving 4286 patients (NT-SV: 2155; CON-SV: 2131) were analyzed. NT-SV was associated with a significantly lower incidence of graft failure than CON-SV (IRR, 0.70; 95% CI 0.60–0.82; P < 0.001) at a weighted mean follow-up of 3.7 years; this result was solid in multiple sensitivity analyses. Mortality (IRR, 1.03; 95% CI, 0.72–1.47, P = 0.87) and MACE (IRR, 0.89; 95% CI, 0.67–1.18; P = 0.42) were similar between groups. NT-SV was associated with a higher incidence of leg wound complications (IRR, 1.73; 95% CI, 1.32–2.27; P < 0.001). CONCLUSIONS The NT-SV harvesting technique was associated with a significant reduction in graft failure and an increased risk of wound complications compared to the CON-SV. Further research is warranted to evaluate clinical NT-SV outcomes, and strategies are needed to mitigate NT-SV harvest-site complications.