Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Abstract

Objective

The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials.

Methods

All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,^1,2 in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis. Based on the resultant, 76 studies (23 randomized controlled trials and 53 nonrandomized controlled trials) on 281,459 patients analyzed, consensus statements, and recommendations were generated comparing the risks and benefits of endoscopic versus open conduit harvesting for patients undergoing coronary artery bypass grafting.

Results

Compared with open vein harvest, it is reasonable to perform endoscopic vein harvest of saphenous vein to reduce wound-related complications, postoperative length of stay, and outpatient wound management resources and to increase patient satisfaction (class I, level A). Based on the quality of the conduit and major adverse cardiac events as well as 6-month angiographic patency, endoscopic vein harvest was noninferior to open harvest. It is reasonable to perform endoscopic radial artery harvest to reduce wound-related complication and to increase patient satisfaction (class I, level B-R and B-NR, respectively) with reduction in major adverse cardiac events and noninferior patency rate at 1 and 3 to 5 years (class III, level B-R).

Conclusions

Based on the consensus statements, the consensus panel recommends (class I, level B) that endoscopic saphenous vein and radial artery harvesting should be the standard of care for patients who require these conduits for coronary revascularization.

Keywords

International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS)Endoscopic vein harvesting Endoscopic radial artery harvesting Consensus statement Randomized controlled trials Revascularization Coronary artery bypass grafting

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References

Allen

, Cheng

, Cohn

Endoscopic vascular harvest in coronary artery bypass grafting surgery: a Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005. Innovations. 2005; 1: 51–60.

Cheng

, Allen

, Cohn

Endoscopic vascular harvest in coronary artery bypass grafting surgery: a meta-analysis of randomized trials and controlled trials. Innovations. 2005; 1: 61–74.

Zenati

M.A.

, Shroyer

A.L.

, Collins

J.F.

Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. J Thorac Cardiovasc Surg. 2011; 141: 338–344.

Higgins

J.P.T.

, Green

(editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.

Wells

G.A.

, Shea

, O'Connell

The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Department of Epidemiology and Community Medicine, University of Ottawa, Canada. Available at: http://www.lri.ca/programs/ceu/oxford.htm. Accessed May 31, 2016.

Higgins

J.P.

, Thompson

S.G.

, Deeks

J.J.

, Altman

D.G.

Measuring inconsistency in meta-analyses. BMJ. 2003; 327: 557–560.

Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre. The Cochrane Collaboration. 2014.

Halperin

J.L.

, Levine

G.N.

, Al-Khatib

S.M.

Further evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016; 67: 1572–1574.

Patel

A.N.

, Henry

A.C.

, Hunnicutt

Endoscopic radial artery harvesting is better than the open technique. Ann Thorac Surg. 2004; 78: 149–153.

10.

Campanella

, Bergamasco

, Macri

Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial. Trials. 2011; 12: 243.

11.

Carranza

C.L.

, Ballegaard

, Werner

M.U.

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2×2 factorial designed randomized NEO trial. Trials [Electronic Resource]. 2014; 15: 135.

12.

Zenati

M.A.

, Gaziano

J.M.

, Collins

J.F.

Choice of vein-harvest technique for coronary artery bypass grafting: rationale and design of the REGROUP trial. Clin Cardiol. 2014; 37: 325–330.

13.

Arsalan

, Gitschmann

, Blumenstein

Influence of endoscopic harvesting on radial artery graft quality. Innovations. 2013; 8: 91.

14.

Desai

, Kiani

, Thiruvanthan

Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency. Ann Thorac Surg. 2011; 91: 1385–1391.

15.

Gelpi

, Lemma

, Mangini

A single system ideal for minimally invasive harvesting of both radial artery and saphenous vein: evidence of safety and efficacy. Interact Cardiovasc Thorac Surg. 2009; 8: S63.

16.

Nezafati

M.H.

, Nezafati

, Amoueian

Immunohistochemistry comparing endoscopic vein extraction vs. Open vein harvesting on saphenous vein endothelium. Innovations. 2014; 9: 198.

17.

Sandker

S.C.

, Speekenbrink

R.G.H.

, Storm van Leeuwen

R.P.H.

Functional and histological analysis of the radial artery: comparison of open vs. endoscopic vessel harvesting. Innovations. 2014; 9: 176.

18.

Namthaisong

, Kasemsan

Endoscopic conduit harvesting and conventional conduit harvesting for coronary artery bypass graft surgery. J Med Assoc Thai. 2012; 95(Suppl 8): S58–S63.

19.

Brat

, Horacek

, Sieja

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a leg-related morbidity and histological comparison. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013; 157: 70–74.

20.

Andreasen

J.J.

, Nekrasas

, Dethlefsen

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial. Eur J Cardiothorac Surg. 2008; 34: 384–389.

21.

Andreasen

J.J.

, Vadmann

, Oddershede

Decreased patency rates following endoscopic vein harvest in coronary artery bypass surgery. Scand Cardiovasc J. 2015; 49: 286–292.

22.

W.K.

, Chiu

S.W.

, Sun

M.P.

Improved leg wound healing with endoscopic saphenous vein harvest in coronary artery bypass graft surgery: a prospective randomized study in Asian population. J Card Surg. 2008; 23: 633–637.

23.

Cherniavskii

A.M.

, Volkov

A.M.

, Lavreniuk

O.V.

, Terekhov

I.N.

, Kareva

IuE

. Comparative assessment of endoscopic and open methods of autovenous conduit exposure for coronary artery bypass grafting operations. Angiol Sosud Khir. 2014; 20: 130–136.

24.

Chernyavskiy

, Volkov

, Lavrenyuk

, Terekhov

, Kareva

Comparative results of endoscopic and open methods of vein harvesting for coronary artery bypass grafting: a prospective randomized parallel-group trial. J Cardiothorac Surg. 2015; 10: 163.

25.

Grus

, Lambert

, Grusová

, Rohn

, Lindner

Endoscopic versus miniinvasive radial artery graft harvesting for purposes of aortocoronary bypass. Prague Med Rep. 2011; 112: 115–123.

26.

Kiaii

, Swinamer

, Fox

A prospective randomized study of endoscopic versus conventional harvesting of the radial artery. Innovations. 2017; 12: 231–238.

27.

Krishnamoorthy

, Critchley

W.R.

, Glover

A.T.

A randomized study comparing three groups of vein harvesting methods for coronary artery bypass grafting: endoscopic harvest versus standard bridging and open techniques. Interact Cardiovasc Thorac Surg. 2012; 15: 224–228.

28.

Rudez

, Unic

, Sutlic

Endoscopic radial artery harvesting reduces postoperative pain and neurologic complications. Heart Surg Forum. 2007; 10: E363–E365.

29.

Shapira

O.M.

, Eskenazi

B.R.

, Hunter

C.T.

Endoscopic versus conventional radial artery harvest—is smaller better?

J Cardiac Surgery. 2006; 21: 329–335.

30.

Wang

D.W.

, Zhang

, Yao

J.M.

Histological alterations of endoscopic versus open saphenous vein harvesting in coronary artery bypass surgery [in Chinese]. J Clin Rehab Tissue Eng Res. 2008; 12: 3567–3570.

31.

Wang

, Wu

, Jiang

Initial experience with endoscopic saphenous vein harvesting for coronary artery bypass grafting in Chinese patients. Heart Surg Forum. 2011; 14: E291–E296.

32.

Allen

K.B.

, Griffith

G.L.

, Heimansohn

D.A.

Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg. 1998; 66: 26–31.

33.

Allen

K.B.

, Heimansohn

D.A.

, Robison

R.J.

Influence of endoscopic versus traditional saphenectomy on event-free survival: five-year follow-up of a prospective randomized trial. Heart Surg Forum. 2003; 6: E143–E145.

34.

Bonde

, Graham

, MacGowan

Endoscopic vein harvest: early results of a prospective trial with open vein harvest. Heart Surg Forum. 2002; 5(Suppl 4): S378–S391.

35.

Bonde

, Graham

A.N.

, MacGowan

S.W.

Endoscopic vein harvest: advantages and limitations. Ann Thorac Surg. 2004; 77: 2076–2082.

36.

Carpino

P.A.

, Khabbaz

K.R.

, Bojar

R.M.

Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000; 119: 69–75.

37.

Cisowski

, Wites

, Gerber

, Drzewiecka-Gerber

, Bochenek

Minimally invasive saphenous vein harvesting for coronary artery bypass grafting—comparison of three less invasive methods. Med Sci Monit. 2000; 6: 735–739.

38.

Fabricius

A.M.

, Diegeler

, Doll

, Weidenbach

, Mohr

F.W.

Minimally invasive saphenous vein harvesting techniques: morphology and postoperative outcome. Ann Thorac Surg. 2000; 70: 473–478.

39.

Folliguet

T.A.

, Le Bret

, Moneta

, Musumeci

, Laborde

Endoscopic saphenous vein harvesting versus ‘open’ technique. A prospective study. Eur J Cardiothorac Surg. 1998; 13: 662–666.

40.

Hayward

III , Hey

L.A.

, Newman

L.L.

Endoscopic versus open saphenous vein harvest: the effect on postoperative outcomes. Ann Thorac Surg. 1999; 68: 2107–2110.

41.

Kiaii

, Moon

B.C.

, Massel

A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2002; 123: 204–212.

42.

Perrault

L.P.

, Jeanmart

, Bilodeau

Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial. J Thorac Cardiovasc Surg. 2004; 127: 1402–1407.

43.

Puskas

J.D.

, Wright

C.E.

, Miller

P.K.

A randomized trial of endoscopic versus open saphenous vein harvest in coronary bypass surgery. Ann Thorac Surg. 1999; 68: 1509–1512.

44.

Lamm

, Juchem

, Milz

, Reichart

Continuous graft perfusion: optimizing the quality of saphenous vein grafts. Heart Surg Forum. 2002; 5(Suppl 4): S355–S361.

45.

Schurr

U.P.

, Lachat

M.L.

, Reuthebuch

Endoscopic saphenous vein harvesting for CABG—a randomized, prospective trial. Thorac Cardiovasc Surg. 2002; 50: 160–163.

46.

Yun

K.L.

, Wu

, Aharonian

Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates. J Thorac Cardiovasc Surg. 2005; 129: 496–503.

47.

Andreas

, Wiedemann

, Stasek

Endoscopic vein harvesting is influenced by patient-related risk factors and may be of specific benefit in female patients. Interact Cardiovasc Thorac Surg. 2013; 17: 603–607.

48.

Bisleri

, Giroletti

, Guarneri

Early- and mid-term outcomes of endoscopic versus open radial artery harvesting: a case-match study. Innovations. 2013; 8: 92.

49.

Bleiziffer

, Hettich

, Eisenhauer

Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting. J Thorac Cardiovasc Surg. 2008; 136: 681–687.

50.

Bleiziffer

, Hettich

, Eisenhauer

Patency rates of endoscopically harvested radial arteries one year after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2007; 134: 649–656.

51.

Chou

N.K.

, Lee

M.L.

, Wang

S.S.

Endoscopic vein harvest in elective offpump coronary artery bypass grafting. J Zhejiang Univ Sci B. 2009; 10: 748–752.

52.

Dacey

L.J.

, Braxton

J.H.

Jr. , Kramer

R.S.

Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting. Circulation. 2011; 123: 147–153.

53.

Dimitrova

, Hoffman

, Geller

Patency of endoscopically harvested radial artery grafts. Innovations. 2009; 4: 157–158.

54.

Dimitrova

K.R.

, Hoffman

D.M.

, Geller

C.M.

Endoscopic radial artery harvest produces equivalent and excellent midterm patency compared with open harvest. Innovations. 2010; 5: 265–269.

55.

Grant

S.W.

, Grayson

A.D.

, Zacharias

What is the impact of endoscopic vein harvesting on clinical outcomes following coronary artery bypass graft surgery?

Heart. 2012; 98: 60–64.

56.

Hassan

, Yip

A.M.

, MacLeod

J.B.

Endoscopic vein harvest is associated with lower rates of leg wound infection at 30 days following cardiac surgery. Can J Cardiol. 2013; 1: S251.

57.

Ikram

M.U.

, Li

W.W.

, Segers

Endoscopic vein-graft harvesting for coronary bypass grafting: good results in patients at risk for surgical site infection. Ned Tijdschr Geneeskd. 2010; 154: 1586–1591.

58.

Inderbitzin

D.T.

, Reuthebuch

, Winkler

Higher surgical site infection rate after endoscopic vein harvest at the lower leg than at the thigh: a prospective analysis including 1251 patients undergoing CABG. Innovations. 2012; 7: 141–142.

59.

Ito

, Tashiro

, Morishige

Endoscopic radial artery harvesting for coronary artery bypass grafting: the initial clinical experience and results of the first 50 patients. Heart Surg Forum. 2009; 12: E310–E315.

60.

Ito

, Tashiro

, Morishige

Early- and mid-term results of endoscopic radial artery harvesting after off-pump coronary artery bypass grafting. Innovations. 2011; 6: 194–195.

61.

Ito

, Tashiro

, Nishimi

Endoscopic radial artery harvesting for coronary artery bypass grafting early and mid-term results. Interact Cardiovasc Thorac Surg. 2011; 12: S18.

62.

Kaur

, Luckraz

, Nagarajan

Cost-benefit of endoscopic vein harvesting in high-risk patients undergoing coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2014; 19: S64.

63.

Kim

, Jeong

, Cho

, Lee

, Cho

Endoscopic radial artery harvesting may be the procedure of choice for coronary artery bypass grafting. Circ J. 2007; 71: 1511–1515.

64.

Kim

D.Y.

, Song

, Kim

H.W.

, Jo

G.H.

, Kang

Early outcomes of endoscopic vein harvesting during the initial learning period. Korean J Thorac Cardiovasc Surg. 2015; 48: 174–179.

65.

Kirmani

B.H.

, Barnard

J.B.

, Mourad

Mid-term outcomes for endoscopic versus open vein harvest: a case control study. J Cardiothorac Surg. 2010; 5: 44.

66.

Kirmani

B.H.

, Barnard

J.B.

, Mourad

Endoscopic vein harvesting does not affect medium term outcomes. Innovations. 2010; 5: 245.

67.

Lai

, Babb

, Ning

The transition from open to endoscopic saphenous vein harvesting and its clinical impact: The Texas Heart Institute experience. Tex Heart Inst J. 2006; 33: 316–320.

68.

Lopes

R.D.

, Hafley

G.E.

, Allen

K.B.

Endoscopic versus open veingraft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009; 361: 235–244.

69.

Lopes

R.D.

, Hafley

G.E.

, Allen

K.B.

Endoscopic vein harvesting is a strong independent predictor of vein graft failure and worse long-term clinical outcomes in patients undergoing coronary artery bypass graft surgery. Innovations. 2009; 4: 157.

70.

G.T.

, Liu

X.R.

, Zhang

C.J.

Endoscopic saphenous vein harvesting versus open vein harvesting techniques. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015; 37: 420–423.

71.

Medalion

, Fuks

, Sharoni

Limb performance and patient satisfaction after radial artery harvesting: endoscopic versus open techniques. Surg Endosc. 2008; 22: 2638–2642.

72.

Navia

J.L.

, Brozzi

, Chiu

Endoscopic versus open radial artery harvesting for coronary artery bypass grafting. J Cardiovasc Surg (Torino). 2012; 53: 257–263.

73.

Navia

J.L.

, Brozzi

, Chiu

Endoscopic versus open radial artery harvesting for coronary artery bypass grafting. Scand Cardiovasc J. 2011; 45: 279–285.

74.

Nezafati

M.H.

, Nezafati

Descriptive analysis of endoscopic versus traditional open vein harvest technique for coronary artery bypass graft surgery: report of 1974 cases. Iranian Heart Journal. 2014; 14: 17–22.

75.

Ouzounian

, Hassan

, Buth

K.J.

Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting. Ann Thorac Surg. 2010; 89: 403–408.

76.

Raja

S.G.

, Navaratnarajah

, Rochon

4-year outcome analysis of endoscopic vein harvesting for coronary artery bypass grafting. Innovations. 2012; 7: 141.

77.

Shapira

O.M.

, Eskenazi

B.R.

, Anter

Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit. J Thorac Cardiovasc Surg. 2006; 131: 388–394.

78.

Vaidyanathan

K.R.

, Sankar

M.N.

, Cherian

K.M.

Endoscopic vs conventional vein harvesting: a prospective analysis. Asian Cardiovasc Thorac Ann. 2008; 16: 134–138.

79.

Williams

J.B.

, Peterson

E.D.

, Brennan

J.M.

Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012; 308: 475–484.

80.

Yadav

, Attaran

, Trimlett

Equivalent medium-term survival with open and endoscopic vein harvesting in coronary revascularization. Innovations. 2014; 9: 209.

81.

Yadav

, Sobhun

, Trimlett

Endoscopic vein harvesting: short- and mid-term mortality and morbidity compared to open vein harvesting. Innovations. 2012; 7: 142.

82.

Allen

K.B.

, Heimansohn

D.A.

, Robison

R.J.

Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surg Forum. 2000; 3: 325–330.

83.

Alrawi

, Balaya

, Raju

Nitric oxide expression by interleukin-10 in the endoscopic and open methods of vein harvesting in coronary artery bypass surgery. JSLS. 2002; 6: 5–9.

84.

Alrawi

S.J.

, Balaya

, Raju

, Cunningham

J.N.

Jr. , Acinapura

A.J.

A comparative study of endothelial cell injury during open and endoscopic saphenectomy: an electron microscopic evaluation. Heart Surg Forum. 2001; 4: 120–127.

85.

Alrawi

S.J.

, Raju

, Satheesan

, Cunningham

J.N.

Jr. , Acinapura

A.J.

Interleukin-1, interleukin-2 and interleukin-10 expression in different techniques of saphenous vein harvesting. Heart Surg Forum. 2001; 4: 47–52.

86.

Alrawi

S.J.

, Samee

, Ramanathan

Intercellular and vascular cell adhesion molecule levels in endoscopic and open saphenous vein harvesting for coronary artery bypass surgery. Heart Surg Forum. 2000; 3: 241–245.

87.

Bitondo

J.M.

, Daggett

W.M.

, Torchiana

D.F.

Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications. Ann Thorac Surg. 2002; 73: 523–528.

88.

Brandt

C.P.

, Greene

G.C.

, Pollard

T.R.

Review of efforts to decrease costly leg wound complications in the medicare population following coronary revascularization. Heart Surg Forum. 2003; 6: 258–263.

89.

Coppoolse

, Rees

, Krech

Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients. Eur J Cardiothorac Surg. 1999; 16(Suppl 2): S61–S66.

90.

Crouch

J.D.

, O'Hair

D.P.

, Keuler

J.P.

Open versus endoscopic saphenous vein harvesting: wound complications and vein quality. Ann Thorac Surg. 1999; 68: 1513–1516.

91.

Davis

, Jacobs

H.K.

, Zhang

, Thomas

, Castellanos

Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiovasc Surg. 1998; 116: 228–235.

92.

Felisky

C.D.

, Paull

D.L.

, Hill

M.E.

Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery. Am J Surg. 2002; 183: 576–579.

93.

Folliguet

, Severac-Bastide

, Le Bret

Harvesting of an internal saphenous graft for aorto-coronary bypass using video-surgery [in French]. Arch Mal Coeur Vaiss. 1999; 92: 859–866.

94.

Galbraith

G.F.

, Pica-Furey

A retrospective comparative study of open and endoscopic saphenous vein harvesting. J Endovasc Ther. 2000; 7: 460–468.

95.

Griffith

G.L.

, Allen

K.B.

, Waller

B.F.

Endoscopic and traditional saphenous vein harvest: a histologic comparison. Ann Thorac Surg. 2000; 69: 520–523.

96.

Horvath

K.D.

, Gray

, Benton

, Hill

, Swanstrom

L.L.

Operative outcomes of minimally invasive saphenous vein harvest. Am J Surg. 1998; 175: 391–395.

97.

Isgro

, Weisse

, Voss

Minimally invasive saphenous vein harvesting: is there an improvement of the results with the endoscopic approach?

Eur J Cardiothorac Surg. 1999; 16(Suppl 2): S58–S60.

98.

Kan

C.D.

, Luo

C.Y.

, Yang

Y.J.

Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients. J Card Surg. 1999; 14: 157–162.

99.

C.Y.

, Lai

S.T.

, Yu

T.J.

, Wang

J.S.

Endoscopic vein harvest for coronary artery bypass surgery. Zhonghua Yi Xue Za Zhi (Taipei). 1998; 61: 276–280.

100.

J.Y.

, Wang

S.S.

, Lin

F.Y.

, Tsai

C.H.

, Chu

S.H.

Video-assisted endoscopic saphenous vein harvesting for coronary artery bypass grafting. J Formos Med Assoc. 1998; 97: 819–825.

101.

Lutz

C.W.

, Hillmann

, Lutter

, Schoellhorn

, Beyersdorf

Endoscopic vs. conventional vein harvesting: first results with a new, non-disposable system. Thorac Cardiovasc Surg. 2001; 49: 321–327.

102.

Marty

, von Segesser

L.K.

, Tozzi

Benefits of endoscopic vein harvesting. World J Surg. 2000; 24: 1104–1107.

103.

Meyer

D.M.

, Rogers

T.E.

, Jessen

M.E.

, Estrera

A.S.

, Chin

A.K.

Histologic evidence of the safety of endoscopic saphenous vein graft preparation. Ann Thorac Surg. 2000; 70: 487–491.

104.

Morris

R.J.

, Butler

M.T.

, Samuels

L.E.

Minimally invasive saphenous vein harvesting. Ann Thorac Surg. 1998; 66: 1026–1028.

105.

Pagni

, Ulfe

E.A.

, Montgomery

W.D.

Clinical experience with the video-assisted saphenectomy procedure for coronary bypass operations. Ann Thorac Surg. 1998; 66: 1626–1631.

106.

Patel

A.N.

, Hebeler

R.F.

, Hamman

B.L.

Prospective analysis of endoscopic vein harvesting. Am J Surg. 2001; 182: 716–719.

107.

Rodrigus

I.E.

, Stockman

, Amsel

B.J.

, Moulijn

A.C.

Should we use videoassisted endoscopic vein harvesting as a standard technique?

Heart Surg Forum. 2001; 4: 53–55.

108.

Terrini

, Graffigna

, Martinelli

A reduction in the invasiveness during surgical revascularization: the harvesting of the great saphenous vein by a video endoscopic technic. Ital Heart J Suppl. 2000; 1: 674–678.

109.

Rao

, Aziz

, Deeba

Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique?

J Thorac Cardiovasc Surg. 2008; 135: 809–815.

110.

Oddershede

, Andreasen

J.J.

, Brocki

B.C.

, Ehlers

Economic evaluation of endoscopic versus open vein harvest for coronary artery bypass grafting. Ann Thorac Surg. 2012; 93: 1174–1180.

111.

Brown

E.N.

, Kon

Z.N.

, Tran

Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins. J Thorac Cardiovasc Surg. 2007; 134: 1259–1265.

112.

Cheng

, Martin

, Ferdinand

F.D.

Endoscopic versus open vein-graft harvesting. N Engl J Med. 2009; 361: 1908–1909.

113.

Cheng

D.C.

, Martin

, Ferdinand

F.D.

Endoscopic vein-graft harvesting: balancing the risk and benefits. Innovations. 2010; 5: 70–73.