Harky Amer, Balmforth Damian, Shipolini Alex, Uppal Rakesh
Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):323-326. doi: 10.1093/icvts/ivx049.
A best evidence topic was written according to a structured protocol. The question addressed was whether endoscopic vein harvesting (EVH) is equivalent to open vein harvesting in terms of graft patency for patients undergoing coronary artery bypass surgery. A total of 417 articles were found using the reported search, of which 4 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these articles are tabulated. Reported outcomes were vein graft failure or patency on coronary angiography or computed tomography angiography at early, mid and long-term follow-up. Of the non-randomized studies reviewed, those with greater patient numbers and longer follow-up periods showed reduced patency rates in the EVH group. Two small early randomized controlled trials demonstrated equivalent patency rates at up to 6 months follow-up. However, a more recent randomized controlled trial showed reduced patency with EVH in 63 patients at a median follow-up of 6.3 years. We conclude that high-quality evidence for the effects of harvesting method on vein graft patency is lacking, with no large randomized trials performed to date. The current evidence suggests that although rates of vein graft failure seem to be similar within the first 6 months following surgery, EVH is associated with reduced graft patency from 12 months onwards.
根据结构化协议撰写了一个最佳证据主题。所探讨的问题是，对于接受冠状动脉搭桥手术的患者，就移植血管通畅率而言，内镜下静脉采集（EVH）是否等同于开放静脉采集。通过报告的检索共找到417篇文章，其中4篇代表了回答该临床问题的最佳证据。这些文章的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结局和结果被制成表格。报告的结局是在早期、中期和长期随访时，冠状动脉造影或计算机断层扫描血管造影显示的静脉移植血管失败或通畅情况。在回顾的非随机研究中，患者数量较多且随访期较长的研究显示，EVH组的通畅率降低。两项小型早期随机对照试验表明，在长达6个月的随访中，通畅率相当。然而，一项更近的随机对照试验显示，在63例患者中，中位随访6.3年时，EVH组的通畅率降低。我们得出结论，目前缺乏关于采集方法对静脉移植血管通畅率影响的高质量证据，迄今为止尚未进行大型随机试验。目前的证据表明，尽管术后头6个月内静脉移植血管失败率似乎相似，但从12个月起，EVH与移植血管通畅率降低有关。
