First experience of the great saphenous vein harvesting with isolated endoscopic technique in coronary bypass surgery
Abstract
Background. In spite of the increasing popularity of the concept of full autoarterial myocardial
revascularization, the great saphenous vein (GSV) still remains one of the most accessible and commonly used autografts.
Aim. To evaluate the results of the first experience of the great saphenous vein endoscopic harvesting for coronary artery bypass surgery.
Material and methods. It was a prospective, randomized study. 60 patients participated in the study.
Patients were divided into 2 groups, the first group – 30 patients who underwent traditional (open)
harvesting of GSV and the second group – 30 patients who underwent endoscopic method.
Results. In endoscopic group the total time of harvesting and wound closure was less than
in the first group, because we spent less time for sutures as the average cut length in this group
was of 5–6 times less than in the first group. Postoperative complications were registered
in 14 (46.2%) patients in the first group and 8 (16.4%) – in the second one.
Conclusion. The advantage of endoscopic vein harvesting is a reduction of pain intensity in the
postoperative period, which favorably influences the early activation of patients and reduces the
time of their hospitalization.
Keywords:coronary heart disease, bypass surgery, great saphenous vein
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (2): 49–56.
DOI: 10.24411/2308-1198-2017-00033
Received: 23.01.2017. Accepted: 19.04.2017.
References
1. Bokeria L.A., Gudkov R.G. Cardiovascular surgery – 2010.
Moscow: NTsSSKh, 2011: 192 p. (in Russian)
2. Cheng D., Allen K., Cohn W., et al. Endoscopic vascular har-
vest in coronary artery bypass grafting surgery: a meta-analysis
of randomized trials and controlled trials. Innovations. 2005; 1 (2):
61–74.
3. Suttner C., Assman A., Boeken U., et al. Endoskopische Saphenektomie in der Koronarchirurgie. Z Herz Thorax Gefаbchir. 2011;
25: 122–8.
4. Schneider Yu.A., Antipov G.N., Isayan M.V. Surgical treatment of coronary heart disease complicated with mitral insufficiency. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and
Cardiovascular Surgery]. 2016; 9 (5): 29–41. (in Russian)
5. Bokeria L.A., Avaliani V.M., Butorin S.P. Venous grafts viability in the short and long-term periods after coronary artery bypass
grafting. Byul. NTsSSKh im. A.N. Bakuleva RAMN [Bulletin Scientific
Center of Cardiovascular Surgery named after A.N. Bakuleva RAMS].
2013; 14 (5): 38–47. (in Russian)
6. Tatoulis J., Wynne R., Skillington P.D., Buxton B.F. Total arterial revascularization: a superior strategy for diabetic patients who
require coronary surgery. Ann Thorac Surg. 2016 Jun 30. pii: S0003-
4975(16)30557-4. doi: 10.1016/j.athoracsur.2016.05.062.
7. Perrotti A., Spina A., Dorigo E., et al. Exclusive bilateral internal thoracic artery grafts for myocardial revascularization requiring four anastomoses or more: outcomes from a single center experience.
Thorac Cardiovasc Surg. 2016 Jul 1. doi: 10.1055/s-0036-1584688.
8. Locker C., Schaff H.V., Daly R.C. Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with percutaneous coronary interventions. J Thorac Cardiovasc Surg. 2016; 152 (2):
369–79.e4. doi: 10.1016/j.jtcvs.2016.03.089.
9. Bleiziffer S., Deutsch M.-A., Lange R. Minimal-invasive Venenentnahme als Standardverfahren in der Bypasschirurgie // Z. Herz Thorax Gefabchir. 2011. Bd 25. S. 129-131.
10. Lumsden A.B., Eaves F.F. 3rd, Ofenloch J.C., Jordan W.D. Subcutaneous, video-assisted saphenous vein harvest: report of the first 30 cases // Cardiovasc. Surg. 1996. Vol. 4, N 6. P. 771-776.
11. Kiaii B., Moon B.C., Massel D., et al. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J. Thorac Cardiovasc
Surg. 2002; 123 (2): 204–12.
12. Athanasiou T., Aziz O., Al-Ruzzeh S., et al. Are wound healing disturbances and length of hospital stay reduced with minimally
invasive vein harvest? A meta-analysis. Eur J Cardiothorac Surg.
2004; 26: 1015–26.
13. Shneider Y.A., Antipov G.N., Belov V.A., et al. Mediastinitis
after cardiac surgery: clinical features, classification and treatment.
New Armenian Med J. 2015; 9 (1): 45–53.
14. Rao C., Aziz O., Deeba S., et al. Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique? J Thorac Cardiovasc Surg. 2008;
135 (4): 809–15.
15. Mullen J.C., Bentley M.J., Mong K., et al. Reduction of leg
wound infections following coronary artery surgery. Can J Cardiol.
1999; 151 (1): 65–8.
16. Taylor G.D., Buchanan-Chell M., Kirkland T., et al. Reduction in surgical wound infection rates associated with reporting data
to surgeons. Can J Infect Dis. 1994; 5: 263–7.
17. Lee K.S., Reinstein L. Lower limb amputation of the donor
site extremity after coronary bypass graft surgery. Arch Phys Med Re-
habil. 1986; 67: 564–5.
18. Allen K., Cheng D., Cohn W., et al. Endoscopic vascular
harvest in coronary artery bypass grafting surgery: a consensus
statement of the international society of minimally invasive cardiothoracic surgery (ISMICS) 2005. Innovations. 2005; 1 (2):
51–60.
19. Williams J.B., Peterson E.D., Brennan J.M., et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012; 308 (5): 475–84.
20. Fabricius A.M., Diegeler A., Doll N., et al. Minimally invasive
saphenous vein harvesting techniques: morphology and postoperative outcome. Ann Thorac Surg. 2000; 70: 473–8.
21. Griffith G.L., Allen K.B., Waller B.F., et al. Endoscopic and
traditional saphenous vein harvest: a histologic comparison. Ann
Thorac Surg. 2000; 69: 520–3.
22. Kiaii B., Moon B.C., Massel D., et al. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J Thorac Cardiovasc
Surg. 2002; 123 (2): 204–12.
23. Suttner C., Assman A., Boeken U., et al. Endoskopische Saphenektomie in der Koronarchirurgie. Z Herz Thorax Gefabchir. 2011;
25: 122–8.
24. Levitcheva E.N., Loginova I.Yu., Okuneva G.N., et al.
Characteristics of quality of Life and physical status of patients
with ischemic heart disease and aortic valve disease. Kardiologiya
[Сardiology]. 2009; 49 (4): 4–8. (in Russian)
25. Lopes R.D., Hafley G.E., Allen K.B., et al. Endoscopic versus
open vein-graft harvesting in coronary-artery bypass surgery. N Engl
J Med. 2009; 361: 235–44.
26. Zenati M.A., Shroyer A.L., Collins J.F., et al. Impact of endoscopic versus open saphenous vein harvest technique on late coronary
artery bypass grafting patient outcomes in the ROOBY (Randomized
On/Off Bypass) Trial. J Thorac Cardiovasc Surg. 2011; 141 (2): 338–44.
27. Cheng D., Martin J., Ferdinand F.D., et al. Endoscopic vein-graft harvesting: balancing the risk and benefits. Innovations. 2010;
5 (2): 70–3.
28. Dacey L.J., Braxton J.H., Kramer J.R.S., et al. Long-term
outcomes of endoscopic vein harvesting after coronary artery bypass
grafting. Circulation. 2011; 123: 147–53.
29. Deppe A.-C., Liakopoulus O.J., Choi Y.-H., et al. Endoscopic
vein harvesting for coronary artery bypass grafting: a systematic
review with meta-analysis of 27 789 patients. J Surg Res. 2013;
180: 114–24.
30. Kirmani B.H., Barnard J.B., Mourad F., et al. Mid-term outcomes for endoscopic versus open vein harvest: a case control study.
J Cardiothorac Surg. 2010; 5 (44). URL: http://www.cardiothoracic-surgery.org/ content/5/1/44 (date of access 04.08.2012).