冠状动脉旁路移植术中移植静脉的采集技术：网络系统评价和荟萃分析
Chuang Liu1,2,3, Ming-Xuan Zhang4, Xin-Liang Guan1,2,3
1Department of Cardiovascular Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Objective:
The optimal technique for harvesting the saphenous vein (SVG) in coronary artery bypass grafting (CABG) remains undetermined. This study aimed to assess the efficacy of open vein harvesting (OVH), endoscopic vein harvesting (EVH) and no-touch vein harvesting (NT) in CABG using a network meta-analysis of randomised controlled trials (RCTs).
Methods:
RCTs evaluating the outcomes in patients undergoing CABG with the SVG using OVH, EVH or NT were identified through a systematic search of PubMed, Web of Science and the Cochrane Central Registry up to August 2025. The outcomes analysed included graft failure, graft occlusion, mortality, revascularisation, myocardial infarction (MI) and leg wound infection rates.
Results:
Data from 26 RCTs involving 7254 patients meeting the inclusion criteria were analysed. The network meta-analysis indicated that the graft failure rate in the NT group was significantly lower than in the OVH group (relative risk (RR) 0.62; 95% CI 0.40 to 0.96) and the EVH group (RR 0.41; 95% CI 0.21 to 0.80). The graft occlusion rate in the NT group was significantly lower than in the OVH group (RR 0.66, 95% CI 0.52 to 0.84). However, the leg wound infection rate in the NT group was the highest. No significant differences were observed in mortality, revascularisation and MI rates among the three groups.
Conclusion:
NT was associated with lower graft failure and graft occlusion rates, yet it had higher leg wound infection rates, while mortality, revascularisation and MI rates remained comparable among the three techniques. These findings require cautious interpretation, and it is important to balance harvest site complications and the desirability of long-term graft patency.
