Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,<jats:sup>1,2</jats:sup> in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis. Based on the resultant, 76 studies (23 randomized controlled trials and 53 nonrandomized controlled trials) on 281,459 patients analyzed, consensus statements, and recommendations were generated comparing the risks and benefits of endoscopic versus open conduit harvesting for patients undergoing coronary artery bypass grafting. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Compared with open vein harvest, it is reasonable to perform endoscopic vein harvest of saphenous vein to reduce wound-related complications, postoperative length of stay, and outpatient wound management resources and to increase patient satisfaction (class I, level A). Based on the quality of the conduit and major adverse cardiac events as well as 6-month angiographic patency, endoscopic vein harvest was noninferior to open harvest. It is reasonable to perform endoscopic radial artery harvest to reduce wound-related complication and to increase patient satisfaction (class I, level B-R and B-NR, respectively) with reduction in major adverse cardiac events and noninferior patency rate at 1 and 3 to 5 years (class III, level B-R). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Based on the consensus statements, the consensus panel recommends (class I, level B) that endoscopic saphenous vein and radial artery harvesting should be the standard of care for patients who require these conduits for coronary revascularization. </jats:p></jats:sec>

Radial artery harvesting in coronary artery bypass grafting surgery—Endoscopic or open method? A meta-analysis

“…Only eight out of 2462 patients died in hospital or within 30 days, of which two underwent EAH and six underwent OAH. The in-hospital or 30-day mortality rate is insignificantly low for both groups, which supported the findings in the meta-analysis of Cao et al [49], Wu et al [48] and Ferdinand et al [51]. However, their studies lacked follow-ups of long-term survival, which is an important indicator to decide the surgical approach as the main purpose of CABG is to prevent the mortality caused by heart failure in the future.…”

“…Three other meta-analysis studies have reported EAH to be beneficial for decreasing wound infections [7,50,51]. Our study included more literature and demonstrated the significant benefit for preventing wound infections (RR = 0.29, 95% CI = 0.14 to 0.60, p = 0.0009).…”

“…On occasions of lacking p-values or hazard ratios for clinical outcomes, we calculated necessary statistics based on the data provided in the literature and derived the ratios and values for further analysis. There were five meta-analysis studies published [7,[48][49][50][51]. All the articles included in them were also included in our study.…”

A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery

“…These findings align strongly with the recent publication by Zenati and colleagues, who also demonstrate that there is no significant difference in rate of repeat re-vascularisation post CABG surgery between the EVH and OVH groups (HR, 0.79; 95% CI, 0.54 -1.17; p=0.25) 19 . Current evidence supports the use of endoscopic vein harvesting in multi vessel coronary artery disease 6, 9,24 and it is based on the effectiveness of these techniques, that the International Society of Minimally Invasive Cardiac Surgery consensus statements now recommend (class 1, Level B) that endoscopic vein harvesting should be standard of care for patients 25 .…”

Coronary Artery Bypass: Review of Surgical Techniques and Impact on Long-Term Revascularization Outcomes

“…Despite a growing body of evidence demonstrating equivalent long-term cardiac outcomes between EVH and OVH and lower rates of wound complications with EVH, the question of which technique is superior remains controversial. EVH was endorsed as the standard of care for vein harvest for CABG by the International Society for Minimally Invasive Cardiothoracic Surgery in a 2005 consensus statement and affirmed this position in a 2015 update [ 45 ]. While the superiority of EVH for mitigation of wound complications appears to be settled, questions about the effect of EVH on long-term vein graft patency remain.…”