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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
The effect of endoscopic vein harvesting in coronary artery bypass surgery
1Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Endoscopic vein harvesting (EVH) for coronary artery bypass graft (CABG) surgery shows similar clinical outcomes and graft quality compared to open vein harvesting (OVH). EVH offers improved wound healing and reduced postoperative leg pain.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Minimally Invasive Techniques
Background:
- Coronary artery bypass graft (CABG) surgery frequently utilizes saphenous vein (SV) grafts.
- Comparing endoscopic vein harvesting (EVH) and open vein harvesting (OVH) is crucial for optimizing patient outcomes.
- Assessing graft quality and wound complications is essential for surgical success.
Purpose of the Study:
- To compare clinical outcomes between EVH and OVH in CABG patients.
- To evaluate the quality of SV grafts harvested using EVH versus OVH.
- To assess wound complications and postoperative pain associated with each harvesting technique.
Main Methods:
- A comparative study of 100 patients undergoing elective CABG with multi-vessel coronary artery disease.
- Fifty patients underwent OVH, and fifty underwent EVH, with SV specimens preserved.
- Clinical outcomes, 1-year graft patency, endothelium integrity, and wound complications were assessed.
Main Results:
- No significant difference in 1-year graft patency rates or endothelium integrity between EVH and OVH groups.
- Similar rates of angina recurrence and graft occlusion observed in both groups.
- EVH group reported significantly milder postoperative leg pain after day 7 compared to the OVH group.
Conclusions:
- EVH is a safe alternative to OVH in CABG surgery, with comparable clinical outcomes and graft quality.
- EVH demonstrates a potential advantage in improving wound healing and reducing postoperative pain.
- The findings support EVH as a viable option for saphenous vein harvesting in CABG procedures.
Background:
To compare the clinical outcomes, quality of saphenous vein (SV) grafts, and wound complications between endoscopic vein harvesting (EVH) technique and open vein harvesting (OVH) technique in patients with coronary artery bypass graft (CABG) surgery.
Methods:
We reviewed one hundred patients with multi-vessel coronary artery disease who underwent elective CABG and agreed to preserve their SV specimens for study. Fifty patients (OVH group) underwent OVH, and the remaining (EVH group) underwent EVH. The median follow-up time was 12 months. Clinical outcomes, 1-year graft patency rates, endothelium integrity of SV grafts and wound complications were assessed.
Results:
The follow-up time was 12 [12-13] months. Recurrence of angina was observed in 5 patients, with 3 (6.1%) in EVH group and 2 (4%) in OVH group (P=0.68). The endothelium integrity of specimens before distension was similar in both the groups (EVH: 81.1%±6.11% vs. OVH: 80.8%±6.58%, P=0.83). After distension, the endothelium integrity was still similar (EVH: 70.7%±9.73%; OVH: 68.3%±9.60%; P=0.22). Grafts of 5 (11.6%) patients in EVH group were classified as occluded, and 4 (9.8%) patients in OVH group showed occlusion of SV grafts (P=1.0). After day 7, the postoperative leg pain was significantly milder in EVH group than OVH group (1.16±0.76 vs. 2.50±0.91, P<0.01).
Conclusions:
These findings suggest that EVH is not associated with worse clinical outcomes or conduit quality. However, it may have advantage in wound healing.
