Since the introduction of the saphenous vein graft (SVG) for coronary artery bypass grafting (CABG) in 19621, the SVG has remained the most commonly used conduit to the non-LAD territories for more than half a century. However, several issues surrounding the use of SVGs, including higher graft occlusion rates and wound complications from the harvesting process, have been identified in clinical practice. As such, significant interest has been dedicated towards developing harvesting techniques

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... t minimize the risk of these acute and late complications. In this issue of the Journal of Cardiac Surgery, Yokoyama and colleagues compared the impact of open vein harvesting (OVH), endoscopic vein harvesting (EVH) and no-touch vein harvesting (NT) on all-cause mortality, revascularization and graft failure, using a network meta-analysis based on randomized controlled trials and propensity-score matched studies. The results showed that the risk of graft failure was approximately halved amongst patients receiving NT compared with EVH and OVH; importantly, though, NT was not associated with lower all-cause mortality or revascularization risk. To further examine whether the use of NT grafts endow patients with better long-term clinical outcomes, such as mortality, myocardial infarction, and revascularization rates, a large-scaled randomized controlled trial or a patient-level combined meta-analysis is required.