1. THE EVOLUTION OF EVH AND CONDUIT QUALITY
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2. EVH: THE STANDARD OF CARE
Highly evolved systems, developed over the past 15 years
Eight generations of devices, along with accessory line, have been introduced
Product features, harvester training and understanding of physiological mechanisms affecting graft patency has significantly improved
Emphasis on conduit quality and patient outcomes
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3. EVH: THEN & NOW
1995: EVH was an innovative alternative to invasive open surgery
Today, 95% of U.S. hospitals use EVH
Successes supported by 15 years of peer-reviewed, randomized studies
Over 1 million EVH procedures performed worldwide
Developed in 1995, EVH was an innovative new alternative to the invasive open technique for harvest of saphenous and radial vessels in CABG surgeries.
Today, approximately 75% of CABG surgeries and 95% of hospitals in the U.S. utilize EVH as the preferred vessel harvesting method. (2008 STS)
The successes of the technique and ongoing advances in technology have been supported by many peer-reviewed, randomized studies over the past 15 years.
2008 STS Floor Survey and market research data on file. MAQUET Cardiovascular. 2008
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4. EVH: THE EARLY YEARS Tenfold increase in procedures 1997-2000
Clear patient benefits
With clear patient benefits, the procedure has rapidly grown in acceptance; the number of EVH cases in the U.S. increased tenfold from as new clinicians were trained in the technique and additional medical centers adopted the procedure. (2008 STS)
2008 STS Floor Survey and market research data on file. MAQUET Cardiovascular. 2008
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5. EVH: 1999–2000 Reduced patient complications
No histological difference between EVH and open vessel harvesting
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Yun KL, et al. Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates. J Thorac Cardiov Surg. 2005;129:
Davis Z, et al. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiov Surg. 1998;116:
Allen KB, et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg. 1998;66:26-32.
Kan CD, et al. Endoscopic saphenous vein harvest decreases leg wound complications in coronary artery bypass grafting patients. J Cardiac Surg. 1999;1:
Crouch JD, et al. Open versus endoscopic saphenous vein harvesting: wound complications and vein quality. Ann Thorac Surg. 1999;68:
Carpino PA, et al. Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting.
J Thorac Cardiov Surg. 2000;119:69-76.
Patel AN, et al. Prospective analysis of endoscopic vein harvesting. Am J Surg. 2002;73:
Bitondo JM, et al. Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications. Ann Thorac Surg. 2002;73:
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6. EVH: 2003–2005
No significant difference in event-free survival over a 5-year follow-up period1
Largest prospective randomized angiographic study of EVH versus open vessel harvesting: no compromoise in 6-month patency rate2
2005: ISMICS recognizes EVH as The Standard of Care for vessel harvesting for patients undergoing CABG surgery3
In fact, after performing a meta-analysis of twenty-eight EVH clinical studies, an expert panel from ISMICS concluded that EVH should be the “standard of care” for all patients in need of a saphenous vein graft during bypass surgery.
In 2005, the procedure was formally recognized by the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) as a standard of care in CABG procedures.
1. Allen KB, et al. Influence of endoscopic versus traditional saphenectomy on event-free survival: five-year follow-up of a prospective randomized trial. Heart Surg Forum. 2003;6:E
2. Yun KL, et al. Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates. J Thorac Cardiov Surg. 2005;129:
3. Allen KB, et al. Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISIMICS) Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery. Winter 2005;1:51-60.
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7. EVH: 2006–2009
Pre-heparinization gains adoption as “EVH best practice”
Low-dose heparin bolus associated with: – Four-fold reduction in graft failure – Reduction in incidence and volume of residual clot strands
Use of heparin is associated with improved patency in saphenous vein grafts
Researchers found that the use of heparin prior to EVH is associated with improved patency in saphenous vein grafts.
Administration of a low-dose heparin bolus (as low as 2500U) prior to EVH is associated with a four-fold reduction in graft failure and linked to a significant reduction in the incidence and volume of residual clot strands within the vein.
Poston RS, et al. Heparin Administration Prior to Endoscopic Vein Harvest Limits Clot Retention and Improves Graft Patency. Abstract. ISMICS. June 8, 2009.
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8. EVH: 2009–2010 Increased focus on need to optimize conduit quality
Endothelial injury found to decrease long-term graft patency1, 2
– Preventing overdistension with pressure control
– Limiting thermal spread to <1 mm
VASOSHIELD Pressure Controlling Syringe controls vessel distension
VASOVIEW HEMOPRO pre-clinical study demonstrates mean thermal spread of 0.19 mm3
VASOVISION Endoscopic Visualization System
Clinicians understand the importance of protecting the vessel. Overdistension can compromise endothelial integrity. Damage to the endothelium has been shown to decrease long-term graft patency.
MAQUET offers a unique way to protect conduit quality with the VASOSHIELD pressure controlling syringe, a device that gives clinicians consistent control over vessel distension.
VASOVIEW HEMOPRO, the most advanced vessel harvesting system available, can protect the conduit by minimizing thermal spread to less than 1mm.
1. Thatte HS, et al. The coronary bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001; 72: S
2. Angelini GD, et al. Metabolic damage to human saphenous vein graft during preparation for coronary artery bypass grafting. Cardiovasc Res. 1985; 19:
3. Lombardi P. Measurement of thermal spread from use of VASOVIEW® HEMOPRO: study demonstrates minimal thermal injury to endothelium. San Jose, CA
MAQUET Cardiovascular; 2008.
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9. EVH – KEY LEARNINGS FROM EXPERIENCE
Meticulous vein handling protects endothelial integrity
Pre-heparinization has significant clinical benefits
Product ergonomics, control and precision matter
On-going harvester training and support is an important factor for success
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10. TRAINING BUILDS EVH STRENGTH
Optimizing techniques helps improve harvester success
MAQUET Program Resources:
Clinical Expertise Available
Global Sites for Hands-on Opportunities
Visiting Clinical “Ambassadors” from U.S.
Classroom/Workshop events
Leg model practice
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11. MAQUET Cardiovascular is committed to EVH technology
A PROMISING FUTURE
MAQUET Cardiovascular is committed to EVH technology
Continue to refine the market leading VASOVIEW platform
Focus and investment in the field of cardiac surgery
Focused on improving patient outcomes
Close collaboration and partnership with practicing clinicians in the development of next generation products and innovations
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MCV 11
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