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Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Meta-Analysis of Randomized Trials and Controlled Trials

Cheng, Davy MD*; Allen, Keith 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 & Techniques in Cardiothoracic & Vascular Surgery: Winter 2005 - Volume 1 - Issue 2 - pp 61-74
doi: 10.1097/01.gim.0000196316.48694.41
Original Articles

Objective: This meta-analysis sought to determine whether endoscopic vascular graft harvesting (EVH) improves clinical and resource outcomes compared with conventional open graft harvesting (OVH) in adults undergoing coronary artery bypass surgery.

Methods: A comprehensive search was undertaken to identify all randomized and nonrandomized trials of EVH versus OVH up to April 2005. The primary outcome was wound complications. Secondary outcomes included any other clinical morbidity and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD) and their 95% confidence intervals (95% CI) were analyzed.

Results: Thirty-six trials of 9,632 patients undergoing saphenous vein harvest met the inclusion criteria (13 randomized; 23 nonrandomized). Risk of wound complications was significantly reduced by EVH compared with OVH (OR 0.31, 95% CI 0.23-0.41). Similarly, the risk of wound infections was significantly reduced (OR 0.23, 95% CI 0.20–0.53; P < 0.0001). Need for surgical wound intervention was also significantly reduced (OR 0.16, 95% CI 0.08–0.29). The incidence of pain, neuralgia, and patient satisfaction was improved with EVH compared with OVH. Postoperative myocardial infarction, stroke, reintervention for ischemia or angina recurrence, and mortality were not significantly different. Operative time was significantly increased (WMD 15.26 minutes; 95% CI 0.01, 30.51), hospital length of stay was reduced (WMD –0.85 days; 95% CI –1.55, –0.15), and readmissions were reduced (OR 0.53, 95% CI 0.29–0.98). Costs were insufficiently reported to allow for aggregate analysis.

Conclusions: Endoscopic vascular graft harvesting of the saphenous vein reduces wound complications and improves patient satisfaction and resource utilization. Further research is required to determine the incremental cost-effectiveness of EVH versus OVH.

From the *Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada; †The Heart Center of Indiana, Division of Cardiothoracic Surgery, Indianapolis, IN; ‡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.

Support for the meta-analysis and a consensus conference was provided by the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS), which has received unrestricted educational grants from industries that produce surgical technologies.

Presented at the ISMICS 8th Annual Meeting, New York, NY, June 1–4, 2005.

Address correspondence and reprint requests to Dr. Davy Cheng, LHSC-University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5; e-mail: davy.cheng@lhsc.on.ca.

© 2005 Lippincott Williams & Wilkins, Inc.