Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Meta-Analysis of Randomized Trials and Controlled Trials
| Autor: | Mark W. Connolly, Volkmar Falk, Keith B. Allen, Richard Vitali, William E. Cohn, James Edgerton, Janet Martin, Toshiya Ohtsuka, Davy Cheng |
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| Rok vydání: | 2005 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Bypass grafting business.industry General Medicine 030204 cardiovascular system & hematology Surgery law.invention 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine medicine.anatomical_structure Randomized controlled trial law 030220 oncology & carcinogenesis Meta-analysis medicine business Cardiology and Cardiovascular Medicine Vascular graft Artery |
| Zdroj: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 1:61-74 |
| ISSN: | 1559-0879 1556-9845 |
| Popis: | Objective This meta-analysis sought to determine whether endoscopic vascular graft harvesting (EVH) improves clinical and resource outcomes compared with conventional open graft harvesting (OVH) in adults undergoing coronary artery bypass surgery. Methods A comprehensive search was undertaken to identify all randomized and nonrandomized trials of EVH versus OVH up to April 2005. The primary outcome was wound complications. Secondary outcomes included any other clinical morbidity and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD) and their 95% confidence intervals (95% CI) were analyzed. Results Thirty-six trials of 9,632 patients undergoing saphenous vein harvest met the inclusion criteria (13 randomized; 23 nonrandomized). Risk of wound complications was significantly reduced by EVH compared with OVH (OR 0.31, 95% CI 0.23–0.41). Similarly, the risk of wound infections was significantly reduced (OR 0.23, 95% CI 0.20–0.53; P < 0.0001). Need for surgical wound intervention was also significantly reduced (OR 0.16, 95% CI 0.08–0.29). The incidence of pain, neuralgia, and patient satisfaction was improved with EVH compared with OVH. Postoperative myocardial infarction, stroke, reintervention for ischemia or angina recurrence, and mortality were not significantly different. Operative time was significantly increased (WMD 15.26 minutes; 95% CI 0.01, 30.51), hospital length of stay was reduced (WMD −0.85 days; 95% CI −1.55, −0.15), and readmissions were reduced (OR 0.53, 95% CI 0.29–0.98). Costs were insufficiently reported to allow for aggregate analysis. Conclusions Endoscopic vascular graft harvesting of the saphenous vein reduces wound complications and improves patient satisfaction and resource utilization. Further research is required to determine the incremental cost-effectiveness of EVH versus OVH. |
| Databáze: | OpenAIRE |
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