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Pedicled Vein Grafts in Coronary Surgery: Perioperative Data From a Randomized Trial
Øystein Pettersen1, Per Magnus Haram2, Anders Winnerkvist2
1Department of Cardiothoracic Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Harvesting saphenous veins with surrounding tissue for coronary artery bypass grafting (CABG) shows similar infection and bleeding rates. This pedicled vein technique may require longer operation times but offers promising early results for CABG success.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- Saphenous vein graft patency is crucial for coronary artery bypass grafting (CABG) success.
- Previous trials suggest pedicled vein harvesting reduces intimal hyperplasia.
- The impact of pedicled vein harvesting on operative duration, wound infections, and bleeding remains unclear.
Purpose of the Study:
- To evaluate the impact of pedicled saphenous vein harvesting on operative outcomes compared to conventional methods.
- To assess differences in duration of operations, leg wound infections, and postoperative bleeding.
Main Methods:
- A randomized trial involving 100 patients undergoing first-time elective CABG.
- Patients were assigned to either conventional or pedicled vein harvesting.
- Perioperative and postoperative data were collected prospectively.
Main Results:
- Pedicled vein harvesting resulted in a significantly longer extracorporeal circulation time (76 min vs. 65 min).
- No significant differences were observed in cross-clamp time, intraoperative graft flow, postoperative bleeding, or leg wound infections (4% in both groups).
- No reoperations were necessitated by vein graft bleeding.
Conclusions:
- Pedicled vein harvesting is associated with comparable postoperative bleeding and leg wound infection rates in selected CABG patients.
- The technique requires a slightly longer extracorporeal circulation time.
- Early promising results suggest pedicled vein harvesting could become a standard technique for CABG in select patients.
Background:
Less-than-optimal long-term patency of the saphenous vein is one of the main obstacles for the success of coronary artery bypass grafting (CABG). Results from the IMPROVE-CABG trial has shown that harvesting the saphenous vein with a pedicle of perivascular tissue less than 5 mm while using manual distention provides comparable occlusion rates but significantly less intimal hyperplasia at early follow-up. The impact of pedicled veins on duration of operations, leg wound infections, and postoperative bleeding is unknown.
Methods:
One hundred patients undergoing first-time elective CABG were randomly assigned to conventional or pedicled vein harvesting. Perioperative and postoperative data were collected prospectively during the hospital stay and at follow-up.
Results:
Duration of extracorporeal circulation was significantly longer in the pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no significant difference was found in the cross-clamp time. No significant difference was found in intraoperative vein graft flow, postoperative bleeding, or leg wound infections (4% in each group). No reoperations were due to vein graft bleeding.
Conclusions:
Harvesting a pedicled vein provides comparable postoperative bleeding and leg wound infection rates in selected patients. The technique is associated with a slightly longer duration of extracorporeal circulation than harvesting conventional veins. Promising early results using the pedicled vein technique may contribute to a change in standard vein harvesting technique for CABG in selected patients.
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