PDF(Sci-hub)
Abstract：
BACKGROUND: Saphenous vein grafts (SVG) are a commonly used conduit for coronary artery bypass graft (CABG) surgery and can be harvested by either an open or endoscopic technique. Our goal was to evaluate long-term angiographic and clinical outcomes of open compared to endoscopic SVG harvest for CABG.
METHODS: Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality.
RESULTS: Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30-day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34].
CONCLUSIONS: Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.
METHODS: Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality.
RESULTS: Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30-day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34].
CONCLUSIONS: Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.
摘要：
背景：隐静脉移植物（SVG）是冠状动脉旁路移植术（CABG）手术常用的导管，可以通过开放或内窥镜技术获取。我们的目标是评估开放的长期血管造影和临床结果，与内镜下获取的CABG相比。
方法：对英文文献中的所有研究进行了电子检索，这些研究比较了开放和内镜下收集的CABG和至少一年的随访。主要结果是移植物通畅。次要结果包括围手术期发病率和死亡率。
结果：在确定的3,255篇文章中，共纳入11项研究进行分析.在18131名患者中，10,873例（60％）患者接受了开放式SVG收获，7,258例（40％）患者接受了内镜下SVG收获。患者的平均年龄为65岁，87%为男性。总体平均随访期为2.6年。随访期间,接受开放SVG收获的患者每次移植物的移植物通畅性优越[开放82.3%vs.内镜75.1%;OR:0.61(95%CI,0.43-0.87);P=0.01],但术后即刻整体伤口并发症发生率较高[开放3.3%vs.内镜1.1%;OR:0.02(95%CI,0.01-0.06);P<0.001]。接受开放SVG收获的患者术后30天死亡率较高[开放3.4%vs.内镜2.1%;OR:0.59(95%CI,0.37-0.94);P=0.03],但总死亡率没有显著差异[开放4.9%与内镜4.9%;OR:0.34(95%CI,0.50-1.27);P=0.34]。
结论：接受开放式SVG获取技术的患者在平均2.6年的随访时间内，移植物通畅性改善，总死亡率与内镜下SVG获取相当。患者开放的SVG收获有较高的早期伤口并发症和术后30天的死亡率，然而,总死亡率无差异.
方法：对英文文献中的所有研究进行了电子检索，这些研究比较了开放和内镜下收集的CABG和至少一年的随访。主要结果是移植物通畅。次要结果包括围手术期发病率和死亡率。
结果：在确定的3,255篇文章中，共纳入11项研究进行分析.在18131名患者中，10,873例（60％）患者接受了开放式SVG收获，7,258例（40％）患者接受了内镜下SVG收获。患者的平均年龄为65岁，87%为男性。总体平均随访期为2.6年。随访期间,接受开放SVG收获的患者每次移植物的移植物通畅性优越[开放82.3%vs.内镜75.1%;OR:0.61(95%CI,0.43-0.87);P=0.01],但术后即刻整体伤口并发症发生率较高[开放3.3%vs.内镜1.1%;OR:0.02(95%CI,0.01-0.06);P<0.001]。接受开放SVG收获的患者术后30天死亡率较高[开放3.4%vs.内镜2.1%;OR:0.59(95%CI,0.37-0.94);P=0.03],但总死亡率没有显著差异[开放4.9%与内镜4.9%;OR:0.34(95%CI,0.50-1.27);P=0.34]。
结论：接受开放式SVG获取技术的患者在平均2.6年的随访时间内，移植物通畅性改善，总死亡率与内镜下SVG获取相当。患者开放的SVG收获有较高的早期伤口并发症和术后30天的死亡率，然而,总死亡率无差异.
