Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, China.
Int J Surg. 2019 Dec;72:167-173. doi: 10.1016/j.ijsu.2019.11.003. Epub 2019 Nov 9.
Two prevalent harvesting techniques are routinely utilized in coronary artery bypass grafting (CABG): endoscopic vein harvesting (EVH) and open vein harvesting (OVH). Our purpose is to compare mid-term and long-term outcomes between these two techniques for CABG.
After the acquisition of evidence, available studies assessing both harvesting techniques with follow-up precondition (a minimum of one year) were identified. The primary outcome was all-cause mortality. Secondary outcomes of interest included the number of intra-operative graft injuries, leg-wound complications, in-hospital mortality, major adverse cardiac events (MACE) and graft patency.
Twenty-two studies including 27911 patients were identified. The incidences of all-cause mortality, in-hospital death, and MACE were similar between EVH and OVH. EVH was associated with more graft injuries (weighted mean difference (WMD) 0.73; 95% confidence interval (CI) 0.18-1.28; P = 0.009), lower mid-term graft patency (odds ratio (OR) 0.80; 95% CI 0.70-0.91; P = 0.0005), and decreased long-term graft patency (OR 0.15, 95% CI 0.04-0.61; P = 0.008) as compared with OVH. Fewer leg-wound complications were observed in endoscopic harvesting as compared to conventional technique (OR 0.19, 95% CI 0.12-0.30; P < 0.001). Data from subgroup analysis suggested study period as a key factor affecting the outcomes for graft patency.
The risks for all-cause mortality, in-hospital death, and MACE are similar between EVH and OVH. EVH increases conduit injuries and lowers mid-long term graft patency rates, however, study period, with growing surgical expertise, may be associated with better outcomes.
在冠状动脉旁路移植术（CABG）中，通常采用两种流行的血管采集技术：内镜静脉采集（EVH）和开放式静脉采集（OVH）。我们的目的是比较这两种技术用于 CABG 的中期和长期结果。
在获取证据后，确定了评估这两种采集技术并随访（至少一年）的可用研究。主要结果是全因死亡率。感兴趣的次要结果包括术中移植损伤数量、腿部伤口并发症、住院死亡率、主要不良心脏事件（MACE）和移植物通畅性。
共纳入 22 项研究，共计 27911 例患者。EVH 和 OVH 之间的全因死亡率、住院死亡率和 MACE 发生率相似。EVH 与更多的移植损伤相关（加权均数差（WMD）0.73；95%置信区间（CI）0.18-1.28；P=0.009），中期移植物通畅率较低（比值比（OR）0.80；95%CI 0.70-0.91；P=0.0005），长期移植物通畅率降低（OR 0.15，95%CI 0.04-0.61；P=0.008）与 OVH 相比。与传统技术相比，内镜采集的腿部伤口并发症较少（OR 0.19，95%CI 0.12-0.30；P<0.001）。亚组分析数据表明，研究期间是影响移植物通畅性结果的关键因素。
EVH 和 OVH 的全因死亡率、住院死亡率和 MACE 风险相似。EVH 增加了导管损伤，降低了中-长期移植物通畅率，但随着手术技术的不断提高，研究期间可能与更好的结果相关。
