gms | German Medical Science

Introduction: Data from US registries confirm the wide adoption of endoscopic vein harvesting (EVH) in up to 75% of performed coronary artery bypass grafting (CABG) procedures. In Europe and Germany frequency is less than 20%. Reason for refusal might be based on published reports raising serious concerns with regard to the quality and midterm patency of grafts after EVH.

Material and methods: A systematic review of current published literature was performed. Analyzed postoperative outcomes included wound infection, postoperative pain, myocardial infarction, vein graft failure, length of hospital stay and mortality.

Results: Provided evidence on clinical outcomes of endoscopic vein harvesting for coronary artery bypass grafting including a meta-analysis of 27,789 patients from 43 studies (16 randomized controlled trials, 27 observational trials) were identified. Pooled effect estimates revealed a reduced incidence (p < 0.002) for wound infections (OR 0.27; 95%CI 0.22 to 0.32), pain (WMD -1.26, 95%CI -2.07 to -0.44) and length of hospital stay (WMD -0.6 days, 95%CI -1.08 to -0.12). EVH was associated to an increase of the odds for vein graft failure (OR 1.38; 95%CI 1.01 to 1.88, p = 0.0433), a finding that lost statistical difference after pooled analysis of RCTs and studies with high methodological quality. Similarly, graft related endpoints including mortality and myocardial infarction did not differ between the harvesting techniques.

Conclusion: Current strength of evidence underlines clinical benefits for patients after coronary artery bypass grafting (CABG) if vein was harvest endoscopiclly.

In patients undergoing CABG EVH is a safe procedure. EVH is associated to reduced leg wound infections without increasing the midterm risk for vein graft failure, myocardial infarction or mortality, and can be easily performed after a short learning curve.