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A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery
Abstract
S408
Cardiac Surgery (683 – 705) 683 A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery C. Cao 1,2,3 , D. Tian 1 , S. Ang 1 , S. Virk 1,∗ , E. Novis 1 , C. Wilcox 1 , T. Yan 1,4 1 The
Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia 3 University of New South Wales, Sydney, Australia 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia Objective: The radial artery has been demonstrated to provide superior long-term patency outcomes compared to saphenous veins for selected patients who undergo coronary artery bypass graft surgery. Recently, endoscopic radial artery harvesting has been popularised to improve cosmetic and perioperative outcomes. However, concerns have been raised regarding the effects on long-term survival and graft patency of this relatively novel technique. The present meta-analysis aimed to assess the safety and efficacy of endoscopic radial artery harvesting versus the conventional open approach. Methods: A systematic review of the current literature was performed on five electronic databases. All comparative studies on endoscopic versus open radial artery harvesting were included for analysis. Primary endpoints included mortality and recurrent myocardial infarction. Secondary endpoints included graft patency, wound infection, haematoma formation, and paraesthesia. Results: Twelve studies involving 3314 patients were included for meta-analysis according to predefined selection criteria. There were no statistically significant differences in overall mortality, recurrent myocardial infarction or graft patency between the two surgical techniques. However, patients who underwent endoscopic harvesting were found to have significantly lower incidences of wound infection, haematoma formation and paraesthesia. Conclusions: Current literature on endoscopic harvesting of the radial artery for coronary artery bypass graft surgery is limited by relatively short follow-up periods and differences in patient selection and surgical techniques. In addition, there are currently no randomised-controlled trials to provide robust clinical data. However, the available evidence suggests that the endoscopic approach is associated with superior perioperative outcomes without clear evidence demonstrating compromised patency or survival outcomes. http://dx.doi.org/10.1016/j.hlc.2015.06.686
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684 A meta-analysis of robotic versus conventional mitral valve surgery C. Cao 1 , S. Virk 1,∗ , E. Novis 1 , C. Wilcox 1 , T. Yan 1,2 1 The
Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia Objective: The present study is the first meta-analysis to compare the surgical outcomes of robotic versus conventional mitral valve surgery in patients with degenerative mitral valve disease. Methods: A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic versus conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalisation and duration of intensive care unit stay. Echocardiographic outcomes were assessed when possible. Results: Six relevant retrospective studies with comparative data for robotic versus conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalisation and intensive care unit stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. Conclusions: Current evidence on comparative outcomes of robotic versus conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety. http://dx.doi.org/10.1016/j.hlc.2015.06.687
S408
Cardiac Surgery (683 – 705) 683 A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery C. Cao 1,2,3 , D. Tian 1 , S. Ang 1 , S. Virk 1,∗ , E. Novis 1 , C. Wilcox 1 , T. Yan 1,4 1 The
Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia 3 University of New South Wales, Sydney, Australia 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia Objective: The radial artery has been demonstrated to provide superior long-term patency outcomes compared to saphenous veins for selected patients who undergo coronary artery bypass graft surgery. Recently, endoscopic radial artery harvesting has been popularised to improve cosmetic and perioperative outcomes. However, concerns have been raised regarding the effects on long-term survival and graft patency of this relatively novel technique. The present meta-analysis aimed to assess the safety and efficacy of endoscopic radial artery harvesting versus the conventional open approach. Methods: A systematic review of the current literature was performed on five electronic databases. All comparative studies on endoscopic versus open radial artery harvesting were included for analysis. Primary endpoints included mortality and recurrent myocardial infarction. Secondary endpoints included graft patency, wound infection, haematoma formation, and paraesthesia. Results: Twelve studies involving 3314 patients were included for meta-analysis according to predefined selection criteria. There were no statistically significant differences in overall mortality, recurrent myocardial infarction or graft patency between the two surgical techniques. However, patients who underwent endoscopic harvesting were found to have significantly lower incidences of wound infection, haematoma formation and paraesthesia. Conclusions: Current literature on endoscopic harvesting of the radial artery for coronary artery bypass graft surgery is limited by relatively short follow-up periods and differences in patient selection and surgical techniques. In addition, there are currently no randomised-controlled trials to provide robust clinical data. However, the available evidence suggests that the endoscopic approach is associated with superior perioperative outcomes without clear evidence demonstrating compromised patency or survival outcomes. http://dx.doi.org/10.1016/j.hlc.2015.06.686
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684 A meta-analysis of robotic versus conventional mitral valve surgery C. Cao 1 , S. Virk 1,∗ , E. Novis 1 , C. Wilcox 1 , T. Yan 1,2 1 The
Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia Objective: The present study is the first meta-analysis to compare the surgical outcomes of robotic versus conventional mitral valve surgery in patients with degenerative mitral valve disease. Methods: A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic versus conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalisation and duration of intensive care unit stay. Echocardiographic outcomes were assessed when possible. Results: Six relevant retrospective studies with comparative data for robotic versus conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalisation and intensive care unit stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. Conclusions: Current evidence on comparative outcomes of robotic versus conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety. http://dx.doi.org/10.1016/j.hlc.2015.06.687