Ferdinand Francis D, MacDonald John K, Balkhy Husam H, Bisleri Gianluigi, Hwang Ho Young, Northrup Patricia, Trimlett Richard H J, Wei Lai, Kiaii Bob B
From the *Division of Cardiothoracic Surgery, Albany Medical College, Albany, NY USA; †Department of Medicine, University of Western Ontario, London, Ontario, Canada; ‡Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL USA; §Division of Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada; ∥Division of Cardiac Surgery, Seoul National University Hospital, Seoul, South Korea; ¶Department of Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; #Division of Cardiovascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, China; and **Division of Cardiac Surgery, University Campus, Western University, London, Ontario, Canada.
Innovations (Phila). 2017 Sep/Oct;12(5):301-319. doi: 10.1097/IMI.0000000000000410.
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.
All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements, 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.
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).
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.
本次共识会议的目的是通过系统回顾和对随机及非随机临床试验进行荟萃分析，制定并更新关于采用开放手术与内镜技术获取大隐静脉和桡动脉的循证共识声明及建议。
纳入2005年至2015年11月30日期间首次国际微创心胸外科学会共识会议及声明中的所有随机对照试验和非随机对照试验，进行系统回顾和荟萃分析。基于对281459例患者的76项研究（23项随机对照试验和53项非随机对照试验）分析结果，生成了关于冠状动脉旁路移植术患者内镜下与开放手术获取血管桥的风险和益处比较的共识声明及建议。
与开放静脉获取相比，采用内镜下获取大隐静脉以减少伤口相关并发症、术后住院时间和门诊伤口处理资源，并提高患者满意度是合理的（I类，A级）。基于血管桥质量、主要不良心脏事件以及6个月血管造影通畅率，内镜下静脉获取不劣于开放获取。采用内镜下获取桡动脉以减少伤口相关并发症并提高患者满意度是合理的（分别为I类，B-R级和B-NR级），同时可降低主要不良心脏事件，且1年及3至5年的通畅率不劣（III类，B-R级）。
基于共识声明，共识小组建议（I类，B级），对于需要这些血管桥进行冠状动脉血运重建的患者，内镜下获取大隐静脉和桡动脉应作为标准治疗方法。
