eComment: Minimally invasive endoscope-enhanced venous conduit harvesting techniques

Abstract

Historical Pages neuralgia, and patient satisfaction was improved with EVH compared with CVH. Operative time was significantly increased (WMD 15.26 min; 95% CI 0.01, 30.51), length of hospital stay was reduced (WMD -0.85 days; 95% CI -1.55, -0.15), and so were readmissions (ORs0.53; 95% CI 0.29-0.98).Reed w8x conducted a meta-analysis comparing leg wound infections following MIVH and CVH techniques. This showed a significant reduction in wound infection rates in favour of the MIVH group (ORs0.19; 95% CI 0.14-0.25). Similarly, wound healing disturbance rates were significantly improved with MIVH technique (ORs0.26; 95% CI 0.20-0.34).Rao et al. w9x performed a meta-analysis of cost-effectiveness of MIVH. They estimated the health-related quality of life utility (HRQoL) on discharge to be 0.9443 after MIVH and 0.6815 after CVH. Six weeks postoperatively, the utility was 0.9599 after MIVH and 0.8219 after CVH. By using these calculated utility estimates, they suggested that MIVH is a cost-effective alternative to CVH techniques. The incremental cost-effectiveness ratio (ICER) of $19,858.87yquality adjusted life year (QALY) compares favourably with other health care interventions. Probabilistic sensitivity analysis demonstrated with a 95.6% certainty that MIVH was the most cost-effective technique at a cost-effectiveness threshold of $50,000yQALY. Clinical bottom lineWe conclude that EVH reduces the level of postoperative pain, length of hospital stay and wound complication, with a high level of patient satisfaction, but a sub-analysis of a large randomised control trial has recently called into question the medium-to long-term patency of grafts endoscopically harvested. Referencesw1x Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg 2003;2:405-409. w2x versus open vein-graft harvesting in coronary artery bypass surgery. N Engl J Med 2009;361:235-244. w3x Burris N, Schwartz K, Brown J, Kwon M, Pierson III R, Griffith B, Poston R. Incidence of residual clot strands in saphenous vein grafts after endoscopic harvest. Innovations 2006;1:323. w4x Athanasiou T, Aziz O, Al-Ruzzeh S, Philippidis P, Jones C, Purkayastha S, Casula R, Glenville B. Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A metaanalysis. Eur J Cardiothorac Surg 2004;26:1015-1026. w5x Allen K, Cheng D, Cohn W, Connolly M, Edgerton J, Falk V, Martin J, Pharm D, Ohtsuka T, Vitali R. Endoscopic vascular harvest in coronary artery bypass grafting surgery: a consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005. Innovations 2005;1:51. w6x Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S. Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: sixmonth patency rates. J Thorac Cardiovasc Surg 2005;129:496-503. w7x Cheng D, Allen K, Cohn W, Connolly M, Edgerton J, Falk V, M...