Key result
EVH cuts wound infections ~77% versus CVH with no difference in long-term efficacy.
Why the study?
The optimal technique for great saphenous vein harvesting in coronary artery bypass graft surgery remains controversial.
Do different great saphenous vein harvesting techniques (EVH, SBT, CVH, no-touch) affect safety and long-term efficacy outcomes in patients undergoing CABG?
Meta-Analysis (n=6,480)
Do different great saphenous vein harvesting techniques (EVH, SBT, CVH, no-touch) affect safety and long-term efficacy outcomes in patients undergoing CABG?
Effect estimate: 91% risk reduction vs no-touch, 77% risk reduction vs CVH
Endoscopic vein harvesting is the most favorable technique for reducing wound complications and pain in CABG, without compromising long-term graft patency or clinical outcomes.
Favors EVH in CABG to minimize wound infections; confirms equivalent long-term patency, MI, and mortality across techniques.
The great saphenous vein (GSV) graft remains a frequently used conduit for coronary artery bypass graft (CABG) surgery. The optimal technique for GSV harvesting has been the subject of on-going controversy. We therefore sought to conduct a systematic review and meta-analysis of all available GSV harvesting techniques in CABG. A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any GSV harvesting technique, including conventional vein harvesting (CVH), no-touch, standard bridging technique (SBT) and endoscopic vein harvesting (EVH) techniques. We investigated safety and long-term efficacy outcomes. All outcomes were analyzed using the frequentist network meta-analysis. A total of 6480 patients from 34 RCTs were included. For safety outcomes, EVH reduced 91% and 77% risk of wound infection compared to no-touch and CVH, respectively. EVH and SBT also significantly reduced the risk of sensibility disorder and postoperative pain. The techniques were not significantly different regarding long-term efficacy outcomes, including mortality, myocardial infarction and graft patency. For GSV harvesting for CABG, EVH techniques are the most favorable, but in case of using an open technique, no-touch is more recommended than CVH. More effective and safer procedures should be investigated for GSV harvesting in CABG.
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Vuong et al. (2021) conducted a meta-analysis in Coronary artery bypass grafting (n=6,480). Endoscopic vein harvesting (EVH) vs. No-touch and conventional vein harvesting (CVH) was evaluated on Wound infection (91% risk reduction vs no-touch, 77% risk reduction vs CVH). Endoscopic vein harvesting reduced the risk of wound infection by 91% compared to no-touch and 77% compared to conventional vein harvesting, with no significant differences in long-term efficacy.
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