Mid-term and long-term outcomes of endoscopic versus open vein harvesting for coronary artery bypass: A systematic review and meta-analysis

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Coronary artery bypass grafting; Endoscopic vein harvesting; Meta-analysis; Open vein harvesting; Systematic review.