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Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An ISMICS Systematic Review and Consensus
Francis D Ferdinand1, John K MacDonald, Husam H Balkhy
1From 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.
Objective:
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.
Methods:
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.
Results:
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).
Conclusions:
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.