| Author, date and | Patient group | Outcomes | Key results | Comments |
| country | ||||
| Study type | ||||
| (level of evidence) | ||||
| Lopes et al., (2009), | 1753 patients had EVH | Death or myocardial | Death or myocardial infarction | Endoscopic vein-graft harvesting is |
| N Engl J Med, USA, [2] | and 1247 open surgery | infarction at 3 years EVH | (9.3% vs. 7.6%; adjusted hazard | independently associated with vein- |
| vs. conventional technique | ratio, 1.38; 95% confidence | graft failure and adverse clinical | ||
| Retrospective cohort | interval (CI), 1.07–1.77; P=0.01), | outcomes | ||
| study | and death (7.4% vs. 5.8%; | |||
| (level 2b) | adjusted hazard ratio, 1.52; 95% | |||
| CI, 1.13–2.04; P=0.005) | ||||
| Repeat revascularisation | Repeat revascularisation (20.2% | |||
| vs. 17.4%; adjusted hazard ratio, | ||||
| 1.22; 95% CI, 1.01–1.47; | ||||
| P=0.04) | ||||
| Graft failure at 12 and | Patients who underwent | |||
| 18 months | endoscopic harvesting had higher | |||
| rates of vein-graft failure than | ||||
| patients who underwent open | ||||
| harvesting (46.7% vs. 38.0%; | ||||
| P<0.001) | ||||
| Burris et al., (2006), | 44 segments of veins, 20 | Intraluminal clot strands | Clot strands were observed in | Saline distention is not completely |
| Innovations, USA, [3] | uncontrolled pressure | 45.4% (20 of 44) of imaged SVG | effective in removing clot strands | |
| saline distension and | segments (severity of observed | and increases overall graft | ||
| Prospective cohort study | 24 no distension | clots: 54%, mild; 32%, moderate; | thrombogenicity | |
| (level 2b) | 14%, severe) | |||
| Percent endothelial | Compared with grafts distended | |||
| integrity | with saline, vein segments that | |||
| were not distended displayed | ||||
| significantly higher endothelial | ||||
| integrity (60.1%±27.2% vs. | ||||
| 24.7%±24.1%; P=0.05) | ||||
| Luminal tissue factor | Lower tissue factor activity in | |||
| activity | undistented veins (1.28±0.95 | |||
| U/cm2 vs. 12.3±5.5 U/cm2, | ||||
| P=0.001) despite having | ||||
| a higher incidence of clot | ||||
| stands (65.0% vs. 29.1%, | ||||
| P=0.02) | ||||
| Athanasiou et al., (2004), | 27 studies with a total | Non-infective wound | NIWHD were significantly lower | The results from this meta-analysis |
| Eur J Cardiothorac Surg, | of 4953 patients | healing disturbances | in the MIVH group (4%) | show that MIVH is a superior |
| UK, [4] | undergoing coronary | (NIWHD): wound | compared to CVH group (13%) | technique to CVH. There is a |
| artery bypass grafting | drainage, haematoma, | Odds ratio (OR): 0.24; | greater reduction in the level of non- | |
| Meta-analysis | (CABG) | dehiscence, necrosis, and | CI=0.16–0.38 | infective wound healing disturbances |
| (level 1a) | need for surgical | and length of hospital stay with the | ||
| 2442 (49%) patients | debridement and seroma | MIVH compared to CVH | ||
| underwent a minimally | formation | |||
| invasive vein harvest | ||||
| (MIVH) | Length of hospital stay | Weighted mean difference | ||
| (WMD), –1.04; | ||||
| 2511 (51%) underwent | CI=–1.92 to –0.16 | |||
| conventional surgery | ||||
| vein harvest (CVH) | ||||
| Allen et al., (2005), | Systematic review of 36 | Wound related | Reduced by 73% | EVH reduces wound related |
| Innovations, USA, [5] | studies involving 9632 | complications | OR=0.27; 95% CI 0.13–055; | complications and postoperative |
| patients | P<0.0001 | length of stay. Compared to OVH, | ||
| Systematic review | in EVH there are significant | |||
| (level 1a) | Comparison of | Length of postoperative | WMD – 0.85 days; | improvements in patient satisfaction |
| endoscopic vs. open | hospital stay | 95% CI –1.55, –0.15; | and postoperative pain levels | |
| vein harvesting (OVH) | P=0.02 | |||
| Postoperative pain | Visual analogue pain scale points | There were no differences observed | ||
| reduction WMD –2.18 points; | between EVH and OVH, when | |||
| 95% CI –3.56, –0.79; P<0.002 | looking at quality of conduit harvest | |||
| Quality of conduit | OR=2.16; 95% CI 0.71–6.54; | Although average graft harvest time | ||
| harvest | P=0.2 No significant difference | was increased in EVH, the mean | ||
| between EVH and OVH | closure time was significantly less | |||
| than in CVH technique | ||||
| Average time of graft | WMD 7.64 min; 95% CI | |||
| harvest | 0.82–14.46; P<0.03. | |||
| Increased with EVH | ||||
| Mean closure time | WMD – 17.73 min; 95% CI | |||
| –25.65, –9.80; P<0.0001. | ||||
| Significant reduction with EVH | ||||
| Yun et al., (2005), | 200 patients undergoing | Leg wound complications | 7.4% vs. 19.4%; | EVH significantly reduces leg wound |
| J Thorac Cardiovasc Surg, | CABG were | P=0.014. | complications, when compared to | |
| USA, [6] | prospectively | In favour of EVH | OVH. EVH does not compromise | |
| randomized into either | 6th month patency rates. Overall | |||
| Randomized controlled | EVH or CVH groups | Overall occlusion rates | 21.7% for EVH and | patency rates, however, are |
| trial | after 6 months | 17.6% for CVH | not dependent upon method of vein | |
| (level 1b) | harvesting but rather individual | |||
| Evidence of significant | 10.2% of EVH grafts vs. | patient characteristics and target and | ||
| disease (>50% stenosis) | 12.4% of OVH grafts | vein related variables | ||
| 6 months occlusion and | No significant difference between | |||
| disease rates | EVH and CVH (as determined by | |||
| means of univariate analysis | ||||
| P=0.584 | ||||
| By means of multivariable logistic | ||||
| regression, EVH was not found to | ||||
| be a significant risk factor for graft | ||||
| occlusion or disease. The adjusted | ||||
| OR=1.15; 95% CI, 0.65–2.05; | ||||
| P=0.594 | ||||
| Cheng et al., (2005), | 36 studies including | Wound complications | OR=0.31; 95% CI 0.23–0.41; | EVH shows a significant reduction in |
| Innovations, USA, [7] | 9632 patients | P<0.0001 in EVH | wound complication and wound | |
| undergoing CABG | infection rates. The need for surgical | |||
| Meta-analysis | Wound infections | OR=0.23; 95% CI 0.20–0.53; | wound intervention is reduced in | |
| (level 1a) | P<0.0001 | EVH compared to OVH | ||
| Need for surgical wound | OR=0.16; 95% CI 0.08–0.29; | Postoperative pain and patient | ||
| intervention | P<0.0001 | satisfaction were much improved | ||
| with EVH | ||||
| Incidence of pain, neuralgia | Greater improvements seen with | |||
| and patient satisfaction | EVH | Both length of hospital stay and | ||
| readmission rates were reduced in | ||||
| Operative time | WMD 15.26 min; 95% CI 0.01, | EVH | ||
| 30.51; P=0.05. | ||||
| Increased for EVH | Operative time in EVH was | |||
| significantly longer | ||||
| Length of hospital stay | WMD –0.85 days; 95% CI –1.55, | |||
| –0.15; P=0.02 | ||||
| Readmissions | OR=0.53; 95% CI 0.29–0.98; | |||
| P=0.04 | ||||
| Reed, (2008), | 24 studies | Wound infection rates | OR=0.19; 95% CI=0.14–0.25; | MIVH technique significantly |
| Int J Low Extrem | P=0.001 | reduced wound infection rates and | ||
| Wounds, USA, [8] | wound healing disturbances | |||
| Wound healing | OR=0.26; 95% CI=0.20–0.34; | |||
| Meta-analysis | disturbances | P=0.001 | ||
| (level 1a) | ||||
| Rao et al., (2008), | Study of cost- | HRQoL (health related | 0.9443 after MIVH and 0.6815 | By using these calculated utility |
| J Thorac Cardiovasc Surg, | effectiveness of MIVH | quality of life utility) on | after CVH | estimates, Rao et al. suggest that |
| UK, [9] | using a novel statistical | discharge | MIVH is a cost-effective alternative | |
| analysis | to CVH techniques | |||
| Systematic review | Patient data | Six weeks postoperative | 0.9599 after MIVH and 0.8219 | ICER of $19,858.87/QALY |
| (level 1a) | obtained from high | QOL utility | after CVH | compares favourably |
| quality RCTs and | with other health care | |||
| meta-analyses | The incremental cost- | $19,858.87/QALY | interventions | |
| effectiveness ratio (ICER) | ||||
| £Bed stay from 2005 | ||||
| NHS reference costs | Probabilistic sensitivity | 95.6% certainty that MIVH was | ||
| analysis | the most cost-effective technique | |||
| at a cost-effectiveness threshold of | ||||
| $50,000/QALY |
| Author, date and | Patient group | Outcomes | Key results | Comments |
| country | ||||
| Study type | ||||
| (level of evidence) | ||||
| Lopes et al., (2009), | 1753 patients had EVH | Death or myocardial | Death or myocardial infarction | Endoscopic vein-graft harvesting is |
| N Engl J Med, USA, [2] | and 1247 open surgery | infarction at 3 years EVH | (9.3% vs. 7.6%; adjusted hazard | independently associated with vein- |
| vs. conventional technique | ratio, 1.38; 95% confidence | graft failure and adverse clinical | ||
| Retrospective cohort | interval (CI), 1.07–1.77; P=0.01), | outcomes | ||
| study | and death (7.4% vs. 5.8%; | |||
| (level 2b) | adjusted hazard ratio, 1.52; 95% | |||
| CI, 1.13–2.04; P=0.005) | ||||
| Repeat revascularisation | Repeat revascularisation (20.2% | |||
| vs. 17.4%; adjusted hazard ratio, | ||||
| 1.22; 95% CI, 1.01–1.47; | ||||
| P=0.04) | ||||
| Graft failure at 12 and | Patients who underwent | |||
| 18 months | endoscopic harvesting had higher | |||
| rates of vein-graft failure than | ||||
| patients who underwent open | ||||
| harvesting (46.7% vs. 38.0%; | ||||
| P<0.001) | ||||
| Burris et al., (2006), | 44 segments of veins, 20 | Intraluminal clot strands | Clot strands were observed in | Saline distention is not completely |
| Innovations, USA, [3] | uncontrolled pressure | 45.4% (20 of 44) of imaged SVG | effective in removing clot strands | |
| saline distension and | segments (severity of observed | and increases overall graft | ||
| Prospective cohort study | 24 no distension | clots: 54%, mild; 32%, moderate; | thrombogenicity | |
| (level 2b) | 14%, severe) | |||
| Percent endothelial | Compared with grafts distended | |||
| integrity | with saline, vein segments that | |||
| were not distended displayed | ||||
| significantly higher endothelial | ||||
| integrity (60.1%±27.2% vs. | ||||
| 24.7%±24.1%; P=0.05) | ||||
| Luminal tissue factor | Lower tissue factor activity in | |||
| activity | undistented veins (1.28±0.95 | |||
| U/cm2 vs. 12.3±5.5 U/cm2, | ||||
| P=0.001) despite having | ||||
| a higher incidence of clot | ||||
| stands (65.0% vs. 29.1%, | ||||
| P=0.02) | ||||
| Athanasiou et al., (2004), | 27 studies with a total | Non-infective wound | NIWHD were significantly lower | The results from this meta-analysis |
| Eur J Cardiothorac Surg, | of 4953 patients | healing disturbances | in the MIVH group (4%) | show that MIVH is a superior |
| UK, [4] | undergoing coronary | (NIWHD): wound | compared to CVH group (13%) | technique to CVH. There is a |
| artery bypass grafting | drainage, haematoma, | Odds ratio (OR): 0.24; | greater reduction in the level of non- | |
| Meta-analysis | (CABG) | dehiscence, necrosis, and | CI=0.16–0.38 | infective wound healing disturbances |
| (level 1a) | need for surgical | and length of hospital stay with the | ||
| 2442 (49%) patients | debridement and seroma | MIVH compared to CVH | ||
| underwent a minimally | formation | |||
| invasive vein harvest | ||||
| (MIVH) | Length of hospital stay | Weighted mean difference | ||
| (WMD), –1.04; | ||||
| 2511 (51%) underwent | CI=–1.92 to –0.16 | |||
| conventional surgery | ||||
| vein harvest (CVH) | ||||
| Allen et al., (2005), | Systematic review of 36 | Wound related | Reduced by 73% | EVH reduces wound related |
| Innovations, USA, [5] | studies involving 9632 | complications | OR=0.27; 95% CI 0.13–055; | complications and postoperative |
| patients | P<0.0001 | length of stay. Compared to OVH, | ||
| Systematic review | in EVH there are significant | |||
| (level 1a) | Comparison of | Length of postoperative | WMD – 0.85 days; | improvements in patient satisfaction |
| endoscopic vs. open | hospital stay | 95% CI –1.55, –0.15; | and postoperative pain levels | |
| vein harvesting (OVH) | P=0.02 | |||
| Postoperative pain | Visual analogue pain scale points | There were no differences observed | ||
| reduction WMD –2.18 points; | between EVH and OVH, when | |||
| 95% CI –3.56, –0.79; P<0.002 | looking at quality of conduit harvest | |||
| Quality of conduit | OR=2.16; 95% CI 0.71–6.54; | Although average graft harvest time | ||
| harvest | P=0.2 No significant difference | was increased in EVH, the mean | ||
| between EVH and OVH | closure time was significantly less | |||
| than in CVH technique | ||||
| Average time of graft | WMD 7.64 min; 95% CI | |||
| harvest | 0.82–14.46; P<0.03. | |||
| Increased with EVH | ||||
| Mean closure time | WMD – 17.73 min; 95% CI | |||
| –25.65, –9.80; P<0.0001. | ||||
| Significant reduction with EVH | ||||
| Yun et al., (2005), | 200 patients undergoing | Leg wound complications | 7.4% vs. 19.4%; | EVH significantly reduces leg wound |
| J Thorac Cardiovasc Surg, | CABG were | P=0.014. | complications, when compared to | |
| USA, [6] | prospectively | In favour of EVH | OVH. EVH does not compromise | |
| randomized into either | 6th month patency rates. Overall | |||
| Randomized controlled | EVH or CVH groups | Overall occlusion rates | 21.7% for EVH and | patency rates, however, are |
| trial | after 6 months | 17.6% for CVH | not dependent upon method of vein | |
| (level 1b) | harvesting but rather individual | |||
| Evidence of significant | 10.2% of EVH grafts vs. | patient characteristics and target and | ||
| disease (>50% stenosis) | 12.4% of OVH grafts | vein related variables | ||
| 6 months occlusion and | No significant difference between | |||
| disease rates | EVH and CVH (as determined by | |||
| means of univariate analysis | ||||
| P=0.584 | ||||
| By means of multivariable logistic | ||||
| regression, EVH was not found to | ||||
| be a significant risk factor for graft | ||||
| occlusion or disease. The adjusted | ||||
| OR=1.15; 95% CI, 0.65–2.05; | ||||
| P=0.594 | ||||
| Cheng et al., (2005), | 36 studies including | Wound complications | OR=0.31; 95% CI 0.23–0.41; | EVH shows a significant reduction in |
| Innovations, USA, [7] | 9632 patients | P<0.0001 in EVH | wound complication and wound | |
| undergoing CABG | infection rates. The need for surgical | |||
| Meta-analysis | Wound infections | OR=0.23; 95% CI 0.20–0.53; | wound intervention is reduced in | |
| (level 1a) | P<0.0001 | EVH compared to OVH | ||
| Need for surgical wound | OR=0.16; 95% CI 0.08–0.29; | Postoperative pain and patient | ||
| intervention | P<0.0001 | satisfaction were much improved | ||
| with EVH | ||||
| Incidence of pain, neuralgia | Greater improvements seen with | |||
| and patient satisfaction | EVH | Both length of hospital stay and | ||
| readmission rates were reduced in | ||||
| Operative time | WMD 15.26 min; 95% CI 0.01, | EVH | ||
| 30.51; P=0.05. | ||||
| Increased for EVH | Operative time in EVH was | |||
| significantly longer | ||||
| Length of hospital stay | WMD –0.85 days; 95% CI –1.55, | |||
| –0.15; P=0.02 | ||||
| Readmissions | OR=0.53; 95% CI 0.29–0.98; | |||
| P=0.04 | ||||
| Reed, (2008), | 24 studies | Wound infection rates | OR=0.19; 95% CI=0.14–0.25; | MIVH technique significantly |
| Int J Low Extrem | P=0.001 | reduced wound infection rates and | ||
| Wounds, USA, [8] | wound healing disturbances | |||
| Wound healing | OR=0.26; 95% CI=0.20–0.34; | |||
| Meta-analysis | disturbances | P=0.001 | ||
| (level 1a) | ||||
| Rao et al., (2008), | Study of cost- | HRQoL (health related | 0.9443 after MIVH and 0.6815 | By using these calculated utility |
| J Thorac Cardiovasc Surg, | effectiveness of MIVH | quality of life utility) on | after CVH | estimates, Rao et al. suggest that |
| UK, [9] | using a novel statistical | discharge | MIVH is a cost-effective alternative | |
| analysis | to CVH techniques | |||
| Systematic review | Patient data | Six weeks postoperative | 0.9599 after MIVH and 0.8219 | ICER of $19,858.87/QALY |
| (level 1a) | obtained from high | QOL utility | after CVH | compares favourably |
| quality RCTs and | with other health care | |||
| meta-analyses | The incremental cost- | $19,858.87/QALY | interventions | |
| effectiveness ratio (ICER) | ||||
| £Bed stay from 2005 | ||||
| NHS reference costs | Probabilistic sensitivity | 95.6% certainty that MIVH was | ||
| analysis | the most cost-effective technique | |||
| at a cost-effectiveness threshold of | ||||
| $50,000/QALY |
EVH, endoscopic vein harvesting; QALY, quality adjusted life year; SVG, saphenous vein graft; RCT, randomized control trial.
| Author, date and | Patient group | Outcomes | Key results | Comments |
| country | ||||
| Study type | ||||
| (level of evidence) | ||||
| Lopes et al., (2009), | 1753 patients had EVH | Death or myocardial | Death or myocardial infarction | Endoscopic vein-graft harvesting is |
| N Engl J Med, USA, [2] | and 1247 open surgery | infarction at 3 years EVH | (9.3% vs. 7.6%; adjusted hazard | independently associated with vein- |
| vs. conventional technique | ratio, 1.38; 95% confidence | graft failure and adverse clinical | ||
| Retrospective cohort | interval (CI), 1.07–1.77; P=0.01), | outcomes | ||
| study | and death (7.4% vs. 5.8%; | |||
| (level 2b) | adjusted hazard ratio, 1.52; 95% | |||
| CI, 1.13–2.04; P=0.005) | ||||
| Repeat revascularisation | Repeat revascularisation (20.2% | |||
| vs. 17.4%; adjusted hazard ratio, | ||||
| 1.22; 95% CI, 1.01–1.47; | ||||
| P=0.04) | ||||
| Graft failure at 12 and | Patients who underwent | |||
| 18 months | endoscopic harvesting had higher | |||
| rates of vein-graft failure than | ||||
| patients who underwent open | ||||
| harvesting (46.7% vs. 38.0%; | ||||
| P<0.001) | ||||
| Burris et al., (2006), | 44 segments of veins, 20 | Intraluminal clot strands | Clot strands were observed in | Saline distention is not completely |
| Innovations, USA, [3] | uncontrolled pressure | 45.4% (20 of 44) of imaged SVG | effective in removing clot strands | |
| saline distension and | segments (severity of observed | and increases overall graft | ||
| Prospective cohort study | 24 no distension | clots: 54%, mild; 32%, moderate; | thrombogenicity | |
| (level 2b) | 14%, severe) | |||
| Percent endothelial | Compared with grafts distended | |||
| integrity | with saline, vein segments that | |||
| were not distended displayed | ||||
| significantly higher endothelial | ||||
| integrity (60.1%±27.2% vs. | ||||
| 24.7%±24.1%; P=0.05) | ||||
| Luminal tissue factor | Lower tissue factor activity in | |||
| activity | undistented veins (1.28±0.95 | |||
| U/cm2 vs. 12.3±5.5 U/cm2, | ||||
| P=0.001) despite having | ||||
| a higher incidence of clot | ||||
| stands (65.0% vs. 29.1%, | ||||
| P=0.02) | ||||
| Athanasiou et al., (2004), | 27 studies with a total | Non-infective wound | NIWHD were significantly lower | The results from this meta-analysis |
| Eur J Cardiothorac Surg, | of 4953 patients | healing disturbances | in the MIVH group (4%) | show that MIVH is a superior |
| UK, [4] | undergoing coronary | (NIWHD): wound | compared to CVH group (13%) | technique to CVH. There is a |
| artery bypass grafting | drainage, haematoma, | Odds ratio (OR): 0.24; | greater reduction in the level of non- | |
| Meta-analysis | (CABG) | dehiscence, necrosis, and | CI=0.16–0.38 | infective wound healing disturbances |
| (level 1a) | need for surgical | and length of hospital stay with the | ||
| 2442 (49%) patients | debridement and seroma | MIVH compared to CVH | ||
| underwent a minimally | formation | |||
| invasive vein harvest | ||||
| (MIVH) | Length of hospital stay | Weighted mean difference | ||
| (WMD), –1.04; | ||||
| 2511 (51%) underwent | CI=–1.92 to –0.16 | |||
| conventional surgery | ||||
| vein harvest (CVH) | ||||
| Allen et al., (2005), | Systematic review of 36 | Wound related | Reduced by 73% | EVH reduces wound related |
| Innovations, USA, [5] | studies involving 9632 | complications | OR=0.27; 95% CI 0.13–055; | complications and postoperative |
| patients | P<0.0001 | length of stay. Compared to OVH, | ||
| Systematic review | in EVH there are significant | |||
| (level 1a) | Comparison of | Length of postoperative | WMD – 0.85 days; | improvements in patient satisfaction |
| endoscopic vs. open | hospital stay | 95% CI –1.55, –0.15; | and postoperative pain levels | |
| vein harvesting (OVH) | P=0.02 | |||
| Postoperative pain | Visual analogue pain scale points | There were no differences observed | ||
| reduction WMD –2.18 points; | between EVH and OVH, when | |||
| 95% CI –3.56, –0.79; P<0.002 | looking at quality of conduit harvest | |||
| Quality of conduit | OR=2.16; 95% CI 0.71–6.54; | Although average graft harvest time | ||
| harvest | P=0.2 No significant difference | was increased in EVH, the mean | ||
| between EVH and OVH | closure time was significantly less | |||
| than in CVH technique | ||||
| Average time of graft | WMD 7.64 min; 95% CI | |||
| harvest | 0.82–14.46; P<0.03. | |||
| Increased with EVH | ||||
| Mean closure time | WMD – 17.73 min; 95% CI | |||
| –25.65, –9.80; P<0.0001. | ||||
| Significant reduction with EVH | ||||
| Yun et al., (2005), | 200 patients undergoing | Leg wound complications | 7.4% vs. 19.4%; | EVH significantly reduces leg wound |
| J Thorac Cardiovasc Surg, | CABG were | P=0.014. | complications, when compared to | |
| USA, [6] | prospectively | In favour of EVH | OVH. EVH does not compromise | |
| randomized into either | 6th month patency rates. Overall | |||
| Randomized controlled | EVH or CVH groups | Overall occlusion rates | 21.7% for EVH and | patency rates, however, are |
| trial | after 6 months | 17.6% for CVH | not dependent upon method of vein | |
| (level 1b) | harvesting but rather individual | |||
| Evidence of significant | 10.2% of EVH grafts vs. | patient characteristics and target and | ||
| disease (>50% stenosis) | 12.4% of OVH grafts | vein related variables | ||
| 6 months occlusion and | No significant difference between | |||
| disease rates | EVH and CVH (as determined by | |||
| means of univariate analysis | ||||
| P=0.584 | ||||
| By means of multivariable logistic | ||||
| regression, EVH was not found to | ||||
| be a significant risk factor for graft | ||||
| occlusion or disease. The adjusted | ||||
| OR=1.15; 95% CI, 0.65–2.05; | ||||
| P=0.594 | ||||
| Cheng et al., (2005), | 36 studies including | Wound complications | OR=0.31; 95% CI 0.23–0.41; | EVH shows a significant reduction in |
| Innovations, USA, [7] | 9632 patients | P<0.0001 in EVH | wound complication and wound | |
| undergoing CABG | infection rates. The need for surgical | |||
| Meta-analysis | Wound infections | OR=0.23; 95% CI 0.20–0.53; | wound intervention is reduced in | |
| (level 1a) | P<0.0001 | EVH compared to OVH | ||
| Need for surgical wound | OR=0.16; 95% CI 0.08–0.29; | Postoperative pain and patient | ||
| intervention | P<0.0001 | satisfaction were much improved | ||
| with EVH | ||||
| Incidence of pain, neuralgia | Greater improvements seen with | |||
| and patient satisfaction | EVH | Both length of hospital stay and | ||
| readmission rates were reduced in | ||||
| Operative time | WMD 15.26 min; 95% CI 0.01, | EVH | ||
| 30.51; P=0.05. | ||||
| Increased for EVH | Operative time in EVH was | |||
| significantly longer | ||||
| Length of hospital stay | WMD –0.85 days; 95% CI –1.55, | |||
| –0.15; P=0.02 | ||||
| Readmissions | OR=0.53; 95% CI 0.29–0.98; | |||
| P=0.04 | ||||
| Reed, (2008), | 24 studies | Wound infection rates | OR=0.19; 95% CI=0.14–0.25; | MIVH technique significantly |
| Int J Low Extrem | P=0.001 | reduced wound infection rates and | ||
| Wounds, USA, [8] | wound healing disturbances | |||
| Wound healing | OR=0.26; 95% CI=0.20–0.34; | |||
| Meta-analysis | disturbances | P=0.001 | ||
| (level 1a) | ||||
| Rao et al., (2008), | Study of cost- | HRQoL (health related | 0.9443 after MIVH and 0.6815 | By using these calculated utility |
| J Thorac Cardiovasc Surg, | effectiveness of MIVH | quality of life utility) on | after CVH | estimates, Rao et al. suggest that |
| UK, [9] | using a novel statistical | discharge | MIVH is a cost-effective alternative | |
| analysis | to CVH techniques | |||
| Systematic review | Patient data | Six weeks postoperative | 0.9599 after MIVH and 0.8219 | ICER of $19,858.87/QALY |
| (level 1a) | obtained from high | QOL utility | after CVH | compares favourably |
| quality RCTs and | with other health care | |||
| meta-analyses | The incremental cost- | $19,858.87/QALY | interventions | |
| effectiveness ratio (ICER) | ||||
| £Bed stay from 2005 | ||||
| NHS reference costs | Probabilistic sensitivity | 95.6% certainty that MIVH was | ||
| analysis | the most cost-effective technique | |||
| at a cost-effectiveness threshold of | ||||
| $50,000/QALY |
| Author, date and | Patient group | Outcomes | Key results | Comments |
| country | ||||
| Study type | ||||
| (level of evidence) | ||||
| Lopes et al., (2009), | 1753 patients had EVH | Death or myocardial | Death or myocardial infarction | Endoscopic vein-graft harvesting is |
| N Engl J Med, USA, [2] | and 1247 open surgery | infarction at 3 years EVH | (9.3% vs. 7.6%; adjusted hazard | independently associated with vein- |
| vs. conventional technique | ratio, 1.38; 95% confidence | graft failure and adverse clinical | ||
| Retrospective cohort | interval (CI), 1.07–1.77; P=0.01), | outcomes | ||
| study | and death (7.4% vs. 5.8%; | |||
| (level 2b) | adjusted hazard ratio, 1.52; 95% | |||
| CI, 1.13–2.04; P=0.005) | ||||
| Repeat revascularisation | Repeat revascularisation (20.2% | |||
| vs. 17.4%; adjusted hazard ratio, | ||||
| 1.22; 95% CI, 1.01–1.47; | ||||
| P=0.04) | ||||
| Graft failure at 12 and | Patients who underwent | |||
| 18 months | endoscopic harvesting had higher | |||
| rates of vein-graft failure than | ||||
| patients who underwent open | ||||
| harvesting (46.7% vs. 38.0%; | ||||
| P<0.001) | ||||
| Burris et al., (2006), | 44 segments of veins, 20 | Intraluminal clot strands | Clot strands were observed in | Saline distention is not completely |
| Innovations, USA, [3] | uncontrolled pressure | 45.4% (20 of 44) of imaged SVG | effective in removing clot strands | |
| saline distension and | segments (severity of observed | and increases overall graft | ||
| Prospective cohort study | 24 no distension | clots: 54%, mild; 32%, moderate; | thrombogenicity | |
| (level 2b) | 14%, severe) | |||
| Percent endothelial | Compared with grafts distended | |||
| integrity | with saline, vein segments that | |||
| were not distended displayed | ||||
| significantly higher endothelial | ||||
| integrity (60.1%±27.2% vs. | ||||
| 24.7%±24.1%; P=0.05) | ||||
| Luminal tissue factor | Lower tissue factor activity in | |||
| activity | undistented veins (1.28±0.95 | |||
| U/cm2 vs. 12.3±5.5 U/cm2, | ||||
| P=0.001) despite having | ||||
| a higher incidence of clot | ||||
| stands (65.0% vs. 29.1%, | ||||
| P=0.02) | ||||
| Athanasiou et al., (2004), | 27 studies with a total | Non-infective wound | NIWHD were significantly lower | The results from this meta-analysis |
| Eur J Cardiothorac Surg, | of 4953 patients | healing disturbances | in the MIVH group (4%) | show that MIVH is a superior |
| UK, [4] | undergoing coronary | (NIWHD): wound | compared to CVH group (13%) | technique to CVH. There is a |
| artery bypass grafting | drainage, haematoma, | Odds ratio (OR): 0.24; | greater reduction in the level of non- | |
| Meta-analysis | (CABG) | dehiscence, necrosis, and | CI=0.16–0.38 | infective wound healing disturbances |
| (level 1a) | need for surgical | and length of hospital stay with the | ||
| 2442 (49%) patients | debridement and seroma | MIVH compared to CVH | ||
| underwent a minimally | formation | |||
| invasive vein harvest | ||||
| (MIVH) | Length of hospital stay | Weighted mean difference | ||
| (WMD), –1.04; | ||||
| 2511 (51%) underwent | CI=–1.92 to –0.16 | |||
| conventional surgery | ||||
| vein harvest (CVH) | ||||
| Allen et al., (2005), | Systematic review of 36 | Wound related | Reduced by 73% | EVH reduces wound related |
| Innovations, USA, [5] | studies involving 9632 | complications | OR=0.27; 95% CI 0.13–055; | complications and postoperative |
| patients | P<0.0001 | length of stay. Compared to OVH, | ||
| Systematic review | in EVH there are significant | |||
| (level 1a) | Comparison of | Length of postoperative | WMD – 0.85 days; | improvements in patient satisfaction |
| endoscopic vs. open | hospital stay | 95% CI –1.55, –0.15; | and postoperative pain levels | |
| vein harvesting (OVH) | P=0.02 | |||
| Postoperative pain | Visual analogue pain scale points | There were no differences observed | ||
| reduction WMD –2.18 points; | between EVH and OVH, when | |||
| 95% CI –3.56, –0.79; P<0.002 | looking at quality of conduit harvest | |||
| Quality of conduit | OR=2.16; 95% CI 0.71–6.54; | Although average graft harvest time | ||
| harvest | P=0.2 No significant difference | was increased in EVH, the mean | ||
| between EVH and OVH | closure time was significantly less | |||
| than in CVH technique | ||||
| Average time of graft | WMD 7.64 min; 95% CI | |||
| harvest | 0.82–14.46; P<0.03. | |||
| Increased with EVH | ||||
| Mean closure time | WMD – 17.73 min; 95% CI | |||
| –25.65, –9.80; P<0.0001. | ||||
| Significant reduction with EVH | ||||
| Yun et al., (2005), | 200 patients undergoing | Leg wound complications | 7.4% vs. 19.4%; | EVH significantly reduces leg wound |
| J Thorac Cardiovasc Surg, | CABG were | P=0.014. | complications, when compared to | |
| USA, [6] | prospectively | In favour of EVH | OVH. EVH does not compromise | |
| randomized into either | 6th month patency rates. Overall | |||
| Randomized controlled | EVH or CVH groups | Overall occlusion rates | 21.7% for EVH and | patency rates, however, are |
| trial | after 6 months | 17.6% for CVH | not dependent upon method of vein | |
| (level 1b) | harvesting but rather individual | |||
| Evidence of significant | 10.2% of EVH grafts vs. | patient characteristics and target and | ||
| disease (>50% stenosis) | 12.4% of OVH grafts | vein related variables | ||
| 6 months occlusion and | No significant difference between | |||
| disease rates | EVH and CVH (as determined by | |||
| means of univariate analysis | ||||
| P=0.584 | ||||
| By means of multivariable logistic | ||||
| regression, EVH was not found to | ||||
| be a significant risk factor for graft | ||||
| occlusion or disease. The adjusted | ||||
| OR=1.15; 95% CI, 0.65–2.05; | ||||
| P=0.594 | ||||
| Cheng et al., (2005), | 36 studies including | Wound complications | OR=0.31; 95% CI 0.23–0.41; | EVH shows a significant reduction in |
| Innovations, USA, [7] | 9632 patients | P<0.0001 in EVH | wound complication and wound | |
| undergoing CABG | infection rates. The need for surgical | |||
| Meta-analysis | Wound infections | OR=0.23; 95% CI 0.20–0.53; | wound intervention is reduced in | |
| (level 1a) | P<0.0001 | EVH compared to OVH | ||
| Need for surgical wound | OR=0.16; 95% CI 0.08–0.29; | Postoperative pain and patient | ||
| intervention | P<0.0001 | satisfaction were much improved | ||
| with EVH | ||||
| Incidence of pain, neuralgia | Greater improvements seen with | |||
| and patient satisfaction | EVH | Both length of hospital stay and | ||
| readmission rates were reduced in | ||||
| Operative time | WMD 15.26 min; 95% CI 0.01, | EVH | ||
| 30.51; P=0.05. | ||||
| Increased for EVH | Operative time in EVH was | |||
| significantly longer | ||||
| Length of hospital stay | WMD –0.85 days; 95% CI –1.55, | |||
| –0.15; P=0.02 | ||||
| Readmissions | OR=0.53; 95% CI 0.29–0.98; | |||
| P=0.04 | ||||
| Reed, (2008), | 24 studies | Wound infection rates | OR=0.19; 95% CI=0.14–0.25; | MIVH technique significantly |
| Int J Low Extrem | P=0.001 | reduced wound infection rates and | ||
| Wounds, USA, [8] | wound healing disturbances | |||
| Wound healing | OR=0.26; 95% CI=0.20–0.34; | |||
| Meta-analysis | disturbances | P=0.001 | ||
| (level 1a) | ||||
| Rao et al., (2008), | Study of cost- | HRQoL (health related | 0.9443 after MIVH and 0.6815 | By using these calculated utility |
| J Thorac Cardiovasc Surg, | effectiveness of MIVH | quality of life utility) on | after CVH | estimates, Rao et al. suggest that |
| UK, [9] | using a novel statistical | discharge | MIVH is a cost-effective alternative | |
| analysis | to CVH techniques | |||
| Systematic review | Patient data | Six weeks postoperative | 0.9599 after MIVH and 0.8219 | ICER of $19,858.87/QALY |
| (level 1a) | obtained from high | QOL utility | after CVH | compares favourably |
| quality RCTs and | with other health care | |||
| meta-analyses | The incremental cost- | $19,858.87/QALY | interventions | |
| effectiveness ratio (ICER) | ||||
| £Bed stay from 2005 | ||||
| NHS reference costs | Probabilistic sensitivity | 95.6% certainty that MIVH was | ||
| analysis | the most cost-effective technique | |||
| at a cost-effectiveness threshold of | ||||
| $50,000/QALY |
EVH, endoscopic vein harvesting; QALY, quality adjusted life year; SVG, saphenous vein graft; RCT, randomized control trial.
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