Open or Endoscopic Vein Harvesting for Coronary-Artery Bypass Grafting

Lymphatic complication in open venous harvesting versus endoscopic venous harvesting: a systematic review and meta-analysis

BACKGROUND

The methods for saphenous vein (SV) harvesting include bridging vein harvesting (BVH), open vein harvesting (OVH), and endoscopic vein harvesting (EVH). Lymphatic complications, such as lymphatic leak, lymphedema, lymphangitis, and lymphocele, can arise following SV-harvesting surgery. This study aims to compare the incidence of lymphatic complications in SV harvesting using the OVH surgical method versus EVH.

METHODS

We have systematically searched databases including Scopus, PubMed, and Web of Science until April 2024. Studies were considered eligible for inclusion if they performed SV harvesting and compared lymphatic complications in the EVH with OVH or BVH. Various lymphatic complications and follow-up periods were extracted. A meta-analysis was conducted comparing the relative risk (RR) of lymphatic complications in the EVH group versus the OVH group.

RESULTS

Twelve studies were included. A total of 1934 patients were involved and the majority were male. Follow-up times were from 6 days to 34 months. Results of the meta-analysis showed that the pooled lymphatic complications, lymphatic leak, and lymphedema are significantly higher in OVH versus EVH (RR = 6.78, p value < 0.01; RR = 17.33, p value < 0.01; RR = 8.88, p value < 0.01, respectively). No significant differences in lymphocele rates between the two methods (RR = 1.2, p value = 0.77). Both short-term and long-term follow-ups showed elevated lymphatic complication risks in OVH relative to EVH (RR = 4.91, p value < 0.01; RR = 30.27, p value = 0.03, respectively).

CONCLUSION

EVH is linked to reduced rates of lymphatic complications. Also, OVH had a higher risk of lymphatic complications in the short and long term compared to EVH.

Generalizability of Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial in patients with a history of coronary artery bypass graft surgery

PURPOSE OF REVIEW

Following coronary artery bypass grafting (CABG), there remains persistent risk of ischemic events despite secondary prevention strategies, including low-density lipoprotein cholesterol lowering. Although REDUCE-IT recently demonstrated the benefits of icosapent ethyl (IPE) on reducing ischemic events in a broad population of primary and secondary prevention patients, its generalizability to a contemporary CABG population is not known. This article aims to ascertain the proportion of patients with a history of CABG that would be eligible for IPE treatment.

RECENT FINDINGS

A review of recent literature highlights the presence of residual ischemic following CABG. Using the Québec Heart Database, a repository of contemporary Canadian cardiac patient information, was searched between 1 January 2006 and 31 December 2016, to ascertain generalizability of IPE.

SUMMARY

In a large (N = 12 641), contemporary, Canadian cohort of patients with a history of CABG and currently on statin therapy, 21.9, 33.6 and 26.4% would be eligible for IPE, according to REDUCE-IT, Health Canada, and Food and Drug Administration criteria, respectively. These analyses would support IPE as an adjunct to secondary prevention therapies post-CABG.