People with coronary artery disease are treated with one procedure known as “coronary artery bypass graft surgery” or CABG. This disease is characterised by narrowing of coronary arteries. It is caused by building up of the plaques in the arterial walls, which narrows the inside of the arteries. In this process the oxygen rich blood reaching the heart muscle is reduced. Therefore, the blocked portion is bypassed by treating the narrowed artery with another piece of blood vessels or grafts. One of the methods is harvesting a vein from calf areas of legs or inner thighs usually called the long saphenous vein. It is also called as autologous venous harvesting (Williams et al. 2012).
There are different forms of harvesting procedures such as open of the vein for grafting, and endoscopic vein harvesting. The former is known as the traditional approach. There is a debate on efficacy of the both methods. As per the literature, there are fewer complications with the endoscopic method when compared to the traditional approach. The traditional approach is considered to be associated with complications, increased hospital stay, leg pain, and other. However, the endoscopic method too has its disadvantages. At the time of harvest, there is a risk of injury. There is also probability of deteriorating effect on the vein graft patency (Barnard and Keenan 2010).
In order to decide which type of procedure is most effective and beneficial in treating the coronary artery disease, a critical analysis of the literature will be conducted. Collecting the best evidence will guide the future effective practice. The data collected from the literature review will help health care professionals in clinical judgement and decision-making related to surgeries (Silvestri et al. 2013).
Autologous vein harvesting using the extra luminal vein dissector to obtain the sephaneous vein was found to be beneficial in coronary artery disease patients. The symptomatic benefits include early mobility and low superficial inflammation. There was no excessive trauma to the vein or any sign of distraction injury found in the patients. This technique was found to be more effective than the more traditional dissection technique. There are few studies on this method highlighting drawbacks (Harskamp et al., 2013). Similarly, using the standard bridging technique for autologous vein harvesting when compared to the traditional open harvesting technique was found to be effective in reducing the postoperative leg morbidity. The bridging method was effective in increasing the patient satisfaction as it was found financially viable (Khan et al., 2010). However, there is still limited evidence related to functional quality of the vein using the method.
According to Ouzounian et al. (2010) endoscopic saphenous vein harvest is effective in decreasing the leg wound infections after surgery. It has also been found to improve cosmesis after CABG. On the other hand it has also been found to reduce the graft patency rates. Other studies contradict that endoscopic method is not the sole factor for the mid-term adverse outcomes of in-hospital outcomes. However, drawback of harvesting saphenous vein method includes it limited visibility using endoscope. Even with illumination, the light is only emitted at the distal portion of the endoscope. There is need to periodically cleaning the endoscope lens as it gets frequently soiled on touching the tissue. It is instead considered safer than the open vein harvesting or the excision method.
An extended literature review will be conducted to identify the effective methods of autologous venous harvesting in CABG out of traditional approach and the endoscopic method in reducing the complications after the surgery.
|
3.3 Principal Research Question In patients with coronary heart disease, is endoscopic autologous vein harvesting process more effective than the traditional or open vein harvesting method in terms of reducing complications? |
Literature review will be conducted for accomplishing research objectives. It is the collection of secondary data through series of steps containing extraction of articles, scrutiny, and elimination of the irrelevant articles and analysis of selected articles. The analysis will be based on the review of the abstract, full text, references, and focus on the research question. The results will be critically appraised and the findings are added up. This process is guided by the PRISMA guidelines (Fleming et al. 2014).
The databases to be used from the Cardiff University Library include Google Scholar, Cochrane, Medline, Scopus, and PubMed. The key terms to be used for the search are-
“Coronary artery bypasses surgery”, “CABG graft”, “autologous venous harvesting”, “traditional method”, “endoscopic venous harvesting”, “Saphenous vein harvest, impact of open versus endoscopic method in CABG” and other search terms will be used in various combinations.
For effective search various Boolean operators were used such as OR, AND, and both. These keywords were chosen as mostly used in the abstract and the tile of the journal articles. The inclusion criteria for the search were research paper published in English Language, between 2000-2018 and in UK. Research paper not meeting the inclusion criteria is excluded. The rationale for collecting both old and recent data is the significant amount of research being conducted in that period. It may be important even in today’s practice (Munn et al. 2014).
The research will be conducted in Cardiff University. It has large library with access to variety of databases. Students can access the library anytime of the day and use it to fullest via online portal system. I can access these databases even from my house and anywhere that has the internet facilities such as cyber cafe.
Has informal consent been obtained to access these facilities/participants?
(Staff should also stipulate the source of funding for the research)
All the literature articles will be accessed from the university library. Other resources include computers, laptops, printers, WiFi or internet, notepad, and other stationery. Assistance is taken from seniors, mentors and supervisors to ensure the quality and relevance of the literature review.
Outline the potential ethical issues of the proposed research and how you intend addressing these issues.
The research work involves no communication or involvement with the patients. Literature review is the dry research and the major ethical issue is plagiarism. For this paper, plagiarism will be avoided and all the relevant literature will be cited and the acknowledgement will be stated. The aim is to make the literature review interesting and useful for evidence based practice. The review will be subjected to open scrutiny by the project mentor to judge its worth.
Is NHS R & D approval required? Yes ? No ?
If so which Trusts will be required to give approval?
Is NHS Research Ethics Service approval required? Yes? No ?
Does your research involves children and young people? Yes? No?
If yes, please indicate whether, or not, you have read and understood the University’s Safeguarding Children and Vulnerable Adults Policy
A copy of which can be found at: https://www.cardiff.ac.uk/racdv/ethics/guidelines/FINAL%20Safeguarding%20Children%20&%20VAs%20Policy%202010.doc
Yes- I have read and understand the Policy ?
No – I have not read or understood the Policy ?
(Tick where appropriate)
|
Activity |
Start Date |
Completion Date (Estimated) |
|
Discuss the topic with mentor |
February |
February |
|
Writing the research proposal |
March |
March |
|
Present the proposal to the supervisor and further discussions |
March |
March |
|
Submission of research proposal |
March |
March |
|
Conduct literature review and extract relevant articles to approve from mentor |
April |
April |
|
Critical analysis of the selected papers after approval and elimination of the irrelevant literature |
April |
May |
|
Introduction to dissertation and methodology |
May |
July |
|
Completed literature review as per structure |
July |
August |
|
Consult the dissertation supervisor |
September |
September |
|
Proceed with conclusion and abstract |
October |
October |
|
Proofreading and submission |
October |
November |
References
Barnard, J.B. and Keenan, D.J.M., 2010. Endoscopic saphenous vein harvesting for coronary artery bypass grafts: NICE guidance. Heart, pp.hrt-2010.
Fleming, P.S., Koletsi, D. and Pandis, N., 2014. Blinded by PRISMA: are systematic reviewers focusing on PRISMA and ignoring other guidelines?. PLoS One, 9(5), p.e96407.
Harskamp, R.E., Lopes, R.D., Baisden, C.E., de Winter, R.J. and Alexander, J.H., 2013. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Annals of surgery, 257(5), pp.824-833.
Khan, U.A., Krishnamoorthy, B., Najam, O., Waterworth, P., Fildes, J.E. and Yonan, N., 2010. A comparative analysis of saphenous vein conduit harvesting techniques for coronary artery bypass grafting–standard bridging versus the open technique. Interactive cardiovascular and thoracic surgery, 10(1), pp.27-31.
Munn, Z., Moola, S., Riitano, D. and Lisy, K., 2014. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. International journal of health policy and management, 3(3), p.123.
Ouzounian, M., Hassan, A., Buth, K.J., MacPherson, C., Ali, I.M., Hirsch, G.M. and Ali, I.S., 2010. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting. The Annals of Thoracic Surgery, 89(2), pp.403-408.
Silvestri, G.A., Gonzalez, A.V., Jantz, M.A., Margolis, M.L., Gould, M.K., Tanoue, L.T., Harris, L.J. and Detterbeck, F.C., 2013. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 143(5), pp.e211S-e250S.
Williams, J.B., Peterson, E.D., Brennan, J.M., Sedrakyan, A., Tavris, D., Alexander, J.H., Lopes, R.D., Dokholyan, R.S., Zhao, Y., O’brien, S.M. and Michler, R.E., 2012. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. Jama, 308(5), pp.475-484.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download