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Endoscopic vein harvesting - Research Support Funding

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Project Description

The long saphenous vein remains the most frequently used conduit for coronary artery bypass grafting. Traditionally, the harvesting of this conduit has been by open incision extending upwards from the ankle in the inner side of the leg up to the groin, depending on the number of bypass grafts required. The significant morbidity that can be associated with this method of saphenous vein harvest has led to a general move towards endoscopic vein harvesting which is a minimally invasive approach. The initial concern and claims that EVH could compromise the quality, integrity, and consequently the patency of the saphenous grafts has been convincingly refuted in a large US study (Zenati et al, NEJM 2019;380:132-141). However, this identified the need for suitably qualified surgeons to perform the technique to ensure safety, and did not assess cost-effectiveness.

EVH is still not the standard of care in Hull and at many of UK centres? The level of equipoise of cardiothoracic surgeons, and the main barriers to adoption have not been explored. The additional cost of the procedure is one reason it has not been widely adopted, with patient kits costing approx. £500. However, as the procedure is less invasive, patient recovery, inpatient time and healthcare costs around wound management could be lower and there could be a positive impact on QoL after CABG. There is a need for a fully-powered, pragmatic, cost-effectiveness trial of EVH versus open vein harvesting (OVH) to provide evidence of safety, clinical effectiveness and cost effectiveness. The NIHR HTA programme would be the most suitable funding stream for this application, and the aim of this Research Support Funding application is to conduct the preliminary work required to inform a quality NIHR application and build collaboration between the clinical team and research methodologists.

Status Project Complete
Value £10,631.00
Project Dates Aug 1, 2022 - Jul 31, 2023

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