Endoscopic vs. Conventional Vein Harvesting:First Results with a New, Non-Disposable System

Lutz, Christoph; Hillmann, Ralf; Lutter, G; Schoellhorn, Joachim; Beyersdorf, Friedhelm

doi:10.1055/s-2001-19005

Cited by 18 publications

(5 citation statements)

References 12 publications

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“…Eight studies reported the incidence of post-operative oedema [4,16,21,25,30,32,33,37], with six of these showing a statistically significant reduction with MIVH as compared to the CVH group. Only three of these studies were randomised [4,16,21], with meta-analysis showing a significant reduction in oedema between MIVH (7/90) and CVH groups (30/60) with an odds ratio of 0.06 (CI 0.01-0.36).…”

Section: Meta-analysis Of Oedema Resultsmentioning

confidence: 96%

“…Overall, 22 of the studies reported the incidence of post-operative haematoma [4][5][6][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33]37], with seven of these showing a statistically significant reduction in the MIVH as compared to the CVH group. Eleven of the studies were randomised [4][5][6][15][16][17][18][19][20][21][22], with metaanalysis of these calculating an incidence of haematoma of 53/676 (8%) in MIVH and 93/610 (15%) in CVH groups, with an odds ratio (OR) of 0.43 and confidence interval (CI) of 0.23-0.79, suggesting that this difference is statistically significant.…”

Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

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Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Athanasiou

Aziz

Al‐Ruzzeh

et al. 2004

European Journal of Cardio-Thoracic Surgery

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Minimally invasive great saphenous vein harvest for coronary artery bypass grafting aims to reduce post-operative leg-wound related morbidity. In a meta-analysis of randomised trials we have shown leg wound infection rates to be significantly lower in patients undergoing minimally invasive harvest. This study aims to use meta-analysis to compare the two techniques with regards to non-infective wound healing disturbances (NIWHD) (wound drainage, haematoma, dehiscence, necrosis, need for surgical debridement, and seroma formation). A meta-analysis of all studies published between 1995 and 2002 reporting a comparison between the two techniques was performed. Primary outcomes of interest were the six wound healing disturbances mentioned above and length of hospital stay. Heterogeneity was assessed using graphical exploration and sensitivity analysis with subgroup analysis. Twenty-seven studies published between 1997 and 2002 matched our selection criteria, with a combined total of 4953 subjects, of which 2442(49%) underwent minimally invasive harvest and 2511(51%) underwent conventional surgery. When considering only randomised studies, the total number of non-infective wound disturbances was lower in minimally invasive (4%) as compared to the conventional (13%) group (random effect OR 0.24, CI 0.16-0.38). Similar results were found when only fully matched studies were considered. The absolute risk reduction when comparing the two techniques was calculated to be 0.10, which translates to a number of patients needed to treat of 10. Length of stay was significantly reduced in the minimally invasive group in comparison to the conventional group (random effect weighted mean difference of -1.04, CI -1.92 to -0.16). Our results suggest that NIWHD all reduced with minimally invasive harvest techniques. Despite the limitations of this meta-analysis, we feel we have once again illustrated an important link between minimally invasive great saphenous vein harvest and improved tissue healing when compared to conventional open surgery. This has the potential to reduce wound-related morbidity, infection, post-operative pain, length of hospital stay, and re-admission rate.

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Section: Meta-analysis Of Oedema Resultsmentioning

confidence: 96%

Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Athanasiou

Aziz

Al‐Ruzzeh

et al. 2004

European Journal of Cardio-Thoracic Surgery

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“…Few studies reported on patient satisfaction. 20,40,41,45,101 Patients' satisfaction with pain relief during hospitalization was significantly improved with EVH compared with OVH (MD = 1.88 points, 95% CI = 1.49 to 2.28, 1 study, 144 patients) but was no longer significant at 6-week follow-up (MD = 0.24 points, 95% CI = −0.09 to 0.57, P < 0.00001). Patient satisfaction with ambulation at hospital discharge was significantly improved with EVH compared with OVH (MD = 2.40, 95% CI = 2.02 to 2.75, 1 study, 144 patients, P < 0.00001).…”

Section: Patient Satisfaction Evh Versus Ovhmentioning

confidence: 97%

Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Ferdinand

MacDonald

Balkhy

et al. 2017

Innovations�(Phila)

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Objective 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. Methods All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,1,2 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. Results 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). Conclusions 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.

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“…Several authors have published data on pain or mobility after vein harvesting; however, few authors have published information on both from the same population. 12,[15][16][17][18][19][20] To calculate postoperative utility, we chose to use estimates from Kiaii and colleagues 12 for 3 reasons: (1) it is a recent study; (2) this study is a prospective, randomized controlled trial; and (3) in this study the authors used the same method for quantifying postoperative mobility restriction and pain, a Likert Visual Analogue Scale (VAS). Assuming that VAS scores were normally distributed, the mean and standard deviation VAS scores at discharge and 6 weeks postoperatively were converted to a set of discrete scores between 0 and 3.…”

Section: Calculation Of Incremental Effectsmentioning

confidence: 99%

“…First, the great saphenous vein is the most frequently used conduit during this commonly performed operation, 1,23 and there is considerable morbidity associated with harvesting of the great saphenous vein. 12,[15][16][17][18][19][20] Furthermore, unless the increased clinical effectiveness of an intervention can be shown to justify its incremental cost, then policymakers have no incentive to allocate resources for its widespread adoption. 10,11 Finally, minimally invasive conduit harvesting techniques have the potential to be more widely applied.…”

Section: Implications For Practicementioning

confidence: 99%

Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique?

Rao

Aziz

Deeba

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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Endoscopic vs. Conventional Vein Harvesting:First Results with a New, Non-Disposable System

Abstract: We conclude that the used endoscopic vein harvesting is a safe and cost effective method that can significantly reduce wound complications. An ongoing prospective study should establish our demonstrated data.

Cited by 18 publications

References 12 publications

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique?

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