HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sharif Al-Ruzzeh Pandelis Philippidis Roberto Casula Brian Glenville Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Athanasiou, T. Articles by Glenville, B. Search for Related Content PubMed PubMed Citation Articles by Athanasiou, T. Articles by Glenville, B. Related Collections Minimally invasive surgery

Eur J Cardiothorac Surg 2004;26:1015-1026
© 2004 Elsevier Science NL

Review

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Department of Cardiothoracic Surgery, Imperial College of Science, Technology and Medicine, The National Heart and Lung Institute, St Mary's Hospital London, 70 St Olaf's Road, Fulham, London SW6 7DN, UK

Received 17 May 2004; received in revised form 18 June 2004; accepted 2 July 2004.

^* Corresponding author. Tel.: +44-207-886-1147; fax: +44-207-886-1763. (E-mail: tathan5253{at}aol.com).

Minimally invasive great saphenous vein harvest for coronary artery bypass grafting aims to reduce post-operative leg-wound related morbidity. In a meta-analysis of randomised trials we have shown leg wound infection rates to be significantly lower in patients undergoing minimally invasive harvest. This study aims to use meta-analysis to compare the two techniques with regards to non-infective wound healing disturbances (NIWHD) (wound drainage, haematoma, dehiscence, necrosis, need for surgical debridement, and seroma formation). A meta-analysis of all studies published between 1995 and 2002 reporting a comparison between the two techniques was performed. Primary outcomes of interest were the six wound healing disturbances mentioned above and length of hospital stay. Heterogeneity was assessed using graphical exploration and sensitivity analysis with subgroup analysis. Twenty-seven studies published between 1997 and 2002 matched our selection criteria, with a combined total of 4953 subjects, of which 2442(49%) underwent minimally invasive harvest and 2511(51%) underwent conventional surgery. When considering only randomised studies, the total number of non-infective wound disturbances was lower in minimally invasive (4%) as compared to the conventional (13%) group (random effect OR 0.24, CI 0.16–0.38). Similar results were found when only fully matched studies were considered. The absolute risk reduction when comparing the two techniques was calculated to be 0.10, which translates to a number of patients needed to treat of 10. Length of stay was significantly reduced in the minimally invasive group in comparison to the conventional group (random effect weighted mean difference of –1.04, CI –1.92 to –0.16). Our results suggest that NIWHD all reduced with minimally invasive harvest techniques. Despite the limitations of this meta-analysis, we feel we have once again illustrated an important link between minimally invasive great saphenous vein harvest and improved tissue healing when compared to conventional open surgery. This has the potential to reduce wound-related morbidity, infection, post-operative pain, length of hospital stay, and re-admission rate.

This article has been cited by other articles:

				J. J. Andreasen, V. Nekrasas, and C. Dethlefsen Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 384 - 389. [Abstract] [Full Text] [PDF]

				C. Rao, O. Aziz, S. Deeba, A. Chow, C. Jones, Z. Ni, L. Papastavrou, S. Rahman, A. Darzi, and T. Athanasiou Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique? J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 809 - 815. [Abstract] [Full Text] [PDF]

				K. R Vaidyanathan, M. N Sankar, and K. M Cherian Endoscopic vs Conventional Vein Harvesting: a Prospective Analysis Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 134 - 138. [Abstract] [Full Text] [PDF]

				H. Luckraz, J. Lowe, N. Pugh, and A. A. Azzu Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 188 - 191. [Abstract] [Full Text] [PDF]

				Z. Ma, A. Dong, J. Fan, and H. Cheng Does sleeve lobectomy concomitant with or without pulmonary artery reconstruction (double sleeve) have favorable results for non-small cell lung cancer compared with pneumonectomy? A meta-analysis Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 20 - 28. [Abstract] [Full Text] [PDF]

				J. S. Isenberg, M. J. Romeo, M. Abu-Asab, M. Tsokos, A. Oldenborg, L. Pappan, D. A. Wink, W. A. Frazier, and D. D. Roberts Increasing Survival of Ischemic Tissue by Targeting CD47 Circ. Res., March 16, 2007; 100(5): 712 - 720. [Abstract] [Full Text] [PDF]

				O. Aziz, T. Athanasiou, and A. Darzi Minimally invasive conduit harvesting: a systematic review Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 324 - 333. [Abstract] [Full Text] [PDF]

				O. Aziz, T. Athanasiou, S. S. Panesar, R. Massey-Patel, O. Warren, J. Kinross, S. Purkayastha, R. Casula, B. Glenville, and A. Darzi Does Minimally Invasive Vein Harvesting Technique Affect the Quality of the Conduit for Coronary Revascularization? Ann. Thorac. Surg., December 1, 2005; 80(6): 2407 - 2414. [Abstract] [Full Text] [PDF]