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THE EVOLUTION OF EVH AND CONDUIT QUALITY

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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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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

2008 STS Floor Survey and market research data on file. MAQUET Cardiovascular. 2008

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EVH: THE EARLY YEARS

Tenfold increase in procedures 1997-2000

Clear patient benefits

2008 STS Floor Survey and market research data on file. MAQUET Cardiovascular. 2008

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EVH: 1999–2000

Reduced patient complications

No histological difference between EVH and open vessel harvesting

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;129:496-503.Davis Z, et al. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiov Surg. 1998;116:228-235.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;1:157-162.Crouch JD, et al. Open versus endoscopic saphenous vein harvesting: wound complications and vein quality. Ann Thorac Surg. 1999;68:1513-1516.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;73:523-528.Bitondo JM, et al. Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications. Ann Thorac Surg. 2002;73:523-528.

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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

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:E143-145. 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;129:496-503.3. 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) 2005. Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery. Winter 2005;1:51-60.

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EVH: 2006–2009

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

Poston RS, et al. Heparin Administration Prior to Endoscopic Vein Harvest Limits Clot Retention and Improves Graft Patency. Abstract. ISMICS. June 8, 2009.

Pre-heparinization gains adoption as “EVH best practice”

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EVH: 2009–2010

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

1. Thatte HS, et al. The coronary bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001; 72: S2245-52 2. Angelini GD, et al. Metabolic damage to human saphenous vein graft during preparation for coronary artery bypass grafting. Cardiovasc Res. 1985; 19: 326-34.3. Lombardi P. Measurement of thermal spread from use of VASOVIEW® HEMOPRO: study demonstrates minimal thermal injury to endothelium. San Jose, CA MAQUET Cardiovascular; 2008.

Increased focus on need to optimize conduit quality

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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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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

10. Apr 2023 © MAQUET 10

MCV0000251210. Apr 2023 © MAQUET

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

A PROMISING FUTURE

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