Minimally invasive conduit harvesting: a systematic review.
Minimally invasive conduit harvesting techniques for coronary artery bypass grafting have developed over the past decade, aiming to reduce the morbidity and recovery time associated with the procedure, whilst preserving the quality of the conduit. Two types of commonly harvested free conduits include the great saphenous vein and the radial artery. Although much research has focussed on comparing less invasive and conventional harvest techniques, there is at present no consensus on the areas where one technique is superior to the other. Aspects of conduits that deserve appreciation when comparing minimally invasive and open harvesting techniques include wound healing at the harvest site, the macroscopic, histological and functional quality of the conduit, but perhaps most importantly its long-term angiographic patency. This paper aims to review the literature comparing minimally invasive and conventional conduit harvesting techniques for coronary artery bypass grafting, with regard to the previously mentioned factors. A literature search of Medline, Ovid, Embase and Cochrane databases was used to identify comparative studies published between 1997 and 2005. Outcomes of interest included: wound infection, non-infective healing disturbances, post-operative pain, neurological disturbance, mobility, patient satisfaction, conduit quality (macroscopic, histological and functional) and long-term conduit patency. A scoring system was applied and used to grade the quality of the evidence, based on which a recommendation of it being 'good' (Grade A), 'fair' (Grade B), or 'insufficient' (Grade C) was made. Results showed that there was 'good' evidence to suggest that wound infection and non-infective complications are reduced with minimally invasive harvest as compared to conventional vein harvest. The evidence suggesting that post-operative pain and mobilisation is reduced after minimally invasive vein harvest and that once harvested, the conduits are macroscopically comparable to conventional ones, is only 'fair'. Finally, although initial reports are encouraging, there is at present insufficient evidence to comment on whether minimally invasive radial artery harvesting is better than that of conventional open surgery. Wounds from minimally invasively harvested venous conduits appear to be less prone to complications although more comparative evidence on conduit quality and long-term patency is eagerly awaited.
Aziz
Omer
O
Department of Surgical Oncology and Technology, Imperial College of Science, Technology and Medicine, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, United Kingdom.
Athanasiou
Thanos
T
Darzi
Ara
A
D001026:Coronary Artery Bypass / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D017534:Radial Artery / Q000601:surgery; D012501:Saphenous Vein / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000379:methods*