Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Open vs Endoscopic GSV Harvest for CABG

No description
by

Meghana Kashyap

on 31 January 2017

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Open vs Endoscopic GSV Harvest for CABG

Discussion
Author conclusion: EVH safe for harvesting veins with benefit in PO pain, wound infection, patient satisfaction and no difference in MI or mortality

>50% not prospective over RCT
Analgesics, definitions not standardized
Very few studies for outcomes of vein graft stenosis, occlusion, angina recurrence
Still does not answer the long-term cardiac outcomes whereas there is a clear benefit of EVH for local wound complications
Results
Methods
Results
OVH > EVH
Harvest time: EVH - 53 min > OVH 34 min (p <0.001)

EVH > OVH
30 day wound complications and pain scores EVH > OVH
Cosmesis EVH > OVH

9 EVH converted to OVH (small veins, varicosities, branch avulsion)
Cellulitis in 1/9
LOS equivalent
Discussion
Comparing OVH at calf to EVH at thigh
Only short vein segments harvested
No heparinization
All EVH were harvested by one surgeon whereas OVH was done by multiple (OVH wound infection may be operator dependent)
Study was not designed for long-term follow-up (only 50% included with low power)
CAG is gold standard
CT-CA MDs were not blinded
Average 6 years may not be long enough for 10-15 year expectancy of CABG
Methods
132 elective isolated CABG over 3 years
Randomized to thigh EVH (intention to treat) or calf OVH
Wound follow-up at POD #5 and 1 month
End-points: #1 wound morbidity, cosmesis, hospital LOS, harvest time
Conflicting Data
Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA
et al.
Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med 2009;361:235-44.
(PREVENT IV)
Pros & Cons
Open (OVH)
Well-established
Long incisions
Delayed ambulation
Increased hospital LOS
Background
Open vs Endoscopic GSV Harvest for CABG
Methods
Results
Conclusions
Endoscopic (EVH)
Decreased wound complications
Patient satisfaction/cosmesis
Learning curve
Concern for increased graft occlusion (e.g. thermal injury)
Unknown long-term outcomes
Conflicting Data
Williams JB, Peterson ED, Brennan JM, Sedrakyan A, Tavris D, Alexander JH, et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012;308:475-84.
Based on the current evidence, EVH is superior to OVH for short-term patient satisfaction, cosmesis, and wound complications. Though there may be an increased rate of graft occlusion in EVH, long term occlusion and mortality rates are only hypothesis generating at this time.

EVH is the preferred harvest modality for GSV.

Future multi-center RCT needed:
Long-term follow-up to 10 years
EVH for PAD vs OVH for non-PAD
Standardized perioperative protocol (exercise, smoking cessation, meds)
44 eligible studies (EVH vs OVH only)
19 randomized
25 non-randomized

11 outcomes examined:
Post-op pain
Wound infection, All-cause wound complications
30-day MI, 30-day mortality
Vein graft stenosis, Vein graft occlusion
Angina reccurence
Mid-term MI, Mid-term mortality
Postop pain:
Lower pain score with EVH (p = .001)
Effect size dependent on system used (Ethicon, VasoView, other)
Wound infection
: Lower in EVH (p < 0.0001)
All-cause wound cx
: Lower in EVH (p = 0.006)
Postop MI
: No significant difference
30-day mortality
: No difference in randomized data
Vein graft stenosis
: Only 2 studies available
Vein graft occlusion
: No difference in randomized data
Angina recurrence
: No significant difference
Repeat revascularization
: No significant difference
Mid-term MI
: No significant difference
Mid-term mortality
: No significant difference
CT-CA follow-up of 63/129 patients (median 6.3 year f/u)
>50% stenosis or occlusion
EKG with new Q wave
Deceased included retrospectively
Full transcript