Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: A leg-related morbidity and histological comparison

Brát, Radim; Horáček, Jaroslav; Sieja, Jiri

doi:10.5507/bp.2012.011

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…18 One study was excluding for using a bridging technique that was not considered to be true endoscopic harvest. 19 Ninety-six reports of 76 studies met the predefined inclusion criteria and were included in the review. Twenty-three studies were RCTs and included a total of 2332 randomized patients, and 53 studies including a total of 279,127 patients were nonrandomized case-control and cohort studies.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Ferdinand

MacDonald

Balkhy

et al. 2017

Innovations�(Phila)

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“…In CABG patients, the left mammary artery and/or saphenous grafts were harvested using standardized methods. 21 Endoscopic harvesting was preferred for venous grafts.…”

Section: Methodsmentioning

confidence: 99%

Sonolysis in Prevention of Brain Infarction During Cardiac Surgery (SONORESCUE)

et al. 2016

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Here, we examined whether intraoperative sonolysis can alter the risk of new ischemic lesions in the insonated brain artery territory during coronary artery bypass grafting (CABG) or valve surgery.Silent brain ischemic lesions could be detected in as many as two-thirds of patients after CABG or valve surgery.Patients indicated for CABG or valve surgery were allocated randomly to sonolysis (60 patients, 37 males; mean age, 65.3 years) of the right middle cerebral artery (MCA) during cardiac surgery and control group (60 patients, 37 males; mean age, 65.3 years). Neurologic examination, cognitive function tests, and brain magnetic resonance imaging (MRI) were conducted before intervention as well as 24 to 72 hours and 30 days after surgery.New ischemic lesions on control diffusion-weighted MRI in the insonated MCA territory ≥0.5 mL were significantly less frequent in the sonolysis group than in the control group (13.3% vs 26.7%, P = 0.109). The sonolysis group exhibited significantly reduced median volume of new brain ischemic lesions (P = 0.026). Stenosis of the internal carotid artery ≥50% and smoking were independent predictors of new brain ischemic lesions ≥0.5 mL (odds ratio = 5.685 [1.272–25.409], P = 0.023 and 4.698 [1.092–20.208], P = 0.038, respectively). Stroke or transient ischemic attack occurred only in 2 control patients (P = 0.496). No significant differences were found in scores for postintervention cognitive tests (P > 0.05).This study provides class-II evidence that sonolysis during CABG or valve surgery reduces the risk of larger, new ischemic lesions in the brain.www.clinicaltrials.gov (NCT01591018).

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“…However, it was concluded that this method may be associated with acute endothelial damage of the graft and endoscopic graft harvesting may promote a thrombogenic environment leading to a reduction in graft patency, which requires further investigation of the longterm patency of vascular grafts. This was seen as one of the factors preventing its widespread use by surgeons [27]. The effect of surgical graft harvesting with EVH on CABG outcomes in a meta-analysis study involving 26.525 patients, it was shown that no significant difference was found in terms of mortality, myocardial infarction, revascularization, angina recurrence, and vein graft stenosis during a mean follow-up period of 2.6 years [28].…”

Section: Discussionmentioning

confidence: 99%