Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis

Abstract

Background: Saphenous vein grafts (SVG) are a commonly used conduit for coronary artery bypass graft (CABG) surgery and can be harvested by either an open or endoscopic technique. Our goal was to evaluate long-term angiographic and clinical outcomes of open compared to endoscopic SVG harvest for CABG. Methods: Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality. Results: Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34]. Conclusions: Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.

Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis

“…The use of complex grafts, grafting of secondary coronary branches, and the harvesting technique were also independent risk factors for graft occlusion. Although previous reports suggest greater rates of graft failure with endoscopic vein harvesting, 64 within the SAFINOUS-CABG IPD Consortium endoscopic vein harvesting was associated with reduced risk for occlusion. This could reflect the experienced harvesters employed in the centers of the Consortium.…”

Early and Late Survival and Associated Factors in Patients Undergoing Coronary Artery Bypass Grafting

“…The systematic review and meta-analysis conducted by Kodia on 18,131 patients undergoing CABG showed greater patency via open SVG harvest than endoscopic SVG harvest after a follow-up of around 2.5 years. Patients with open SVG harvest showed higher rates of early wound complications and postoperative 30-day mortality, which, importantly, did not mean differences in overall mortality [1].…”

“…Endoscopic SVG harvest was reported to have short-term graft patency similar to open SVG harvest, although there are concerns for a significantly reduced long-term graft patency at 12 months and beyond. Given the potential implications of endoscopic SVG harvest for deteriorated long-term outcomes in patients undergoing CABG, its role has received much controversy in the literature, although it is generally considered non-subsidiary to open harvest [1].…”

“…CABG continues to be the most common procedure in adult cardiac surgery for coronary artery disease [1]. CABG improves survival, particularly in complex diabetic patients, those above 65 years of age, patients with left main stem or triplevessel disease, and those who have an impairment in the left ventricular function [2].…”

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

“…Although EVH is suggested to be 'minimally invasive' in terms of vessel exposure, wound healing, and scarring, manipulation by instruments and insufflation by CO 2 cause considerable vascular trauma. This potentially impacts on the SV's function as a bypass graft [69][70][71] . The damage inflicted effects not only on the endothelium, but also on other parts of the SV, including the intima and adventitia [69,70] , as well as the perivascular fat [22] , as seen in Figure 5 from Kiani et al, 2011 [69] , and Kopjar et al, 2016 [22] .…”