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Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005

Allen, Keith MD*; Cheng, Davy MD; Cohn, William MD; Connolly, Mark MD§; Edgerton, James MD; Falk, Volkmar MD; Martin, Janet Pharm D; Ohtsuka, Toshiya MD#; Vitali, Richard PA§

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: January 2005 - Volume 1 - Issue 2 - p 51-60
doi: 10.1097/01.gim.0000196315.32179.82
Original Articles

Objective: This purpose of this consensus statement was to compare endoscopic vascular graft harvesting (EVH) with conventional open vascular harvesting (OVH) in adults undergoing coronary artery bypass grafting (CABG) surgery and to determine which resulted in improved clinical and resource outcomes.

Methods: Before the consensus conference, the consensus panel reviewed the best available evidence, whereby systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of importance. Evidence-based statements were created, and consensus processes were used to determine the ensuing statements. The AHA/ACC system was used to label the level of evidence and class of recommendation.

Results: The consensus panel agreed upon the following statements:

  1. EVH is recommended to reduce wound related complications when compared with OVH (Class I, Level A).
  2. Based on quality of conduit harvested, either endoscopic or open vein harvest technique may be used (Class IIa; Level B).
  3. Based on major adverse cardiac events and angiographic patency at 6 months, either endoscopic or open vein harvest technique may be used (Class IIa; Level A).
  4. EVH is recommended for vein harvesting to improve patient satisfaction and postoperative pain when compared with OVH in CABG surgery (Class I, Level A).
  5. EVH is recommended for vein harvesting to reduce postoperative length of stay and outpatient wound management resources (Class I, Level A).

Conclusions: Given these evidence-based statements, the consensus panel stated that EVH should be the standard of care for patients who require saphenous vein grafts for coronary revascularization (Class I, Level B). Future research should address long-term safety, cost-effectiveness, and endoarterial harvest.

From *The Heart Center of Indiana, Division of Cardiothoracic Surgery, Indianapolis, IN; †Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada; ‡Texas Heart Institute, Houston, TX; §St. Michael’s Medical Center, Newark, NJ; ¶Cardiopulmonary Research Science and Technology Institute, Dallas, TX; ‖Klinik fur Herzchirurgie, Herzzentrum Leipzig, Germany; #Department of Cardiothoracic Surgery, Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan.

Presented at the ISMICS 2005 Winter Workshop, Shanghai, China, December 2–4, 2005.

Address correspondence and reprint requests to Dr. Keith Allen, 10590 North Meridian Street, Suite 105, Indianapolis, IN 46260; e-mail: kallen2340@aol.com.

© 2005 Lippincott Williams & Wilkins, Inc.