Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad
Keywords:
endoscopic vein harvesting, open vein harvesting, coronary artery bypass grafting, graft patency, clinical outcome, pathological outcomeAbstract
Introduction: Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes.
Methods: This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis.
Results: The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques.
Conclusion: EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH.
References
Raja SG, Haider Z, Ahmad M, Zaman H. Saphenous vein grafts: to use or not to use? Heart, Lung and
Circulation. 2004;13(2):150-6. Doi: 10.1016/j.hlc.2004.04.004, PMid: 16352226
Liliav B1, Yakoub D, Kasabian A. Necrotizing fasciitis following endoscopic harvesting of the greater
saphenous vein for coronary artery bypass graft. JSLS. 2011 Jan-Mar;15(1):90-5. Doi:
4293/108680811X13022985131453, PMid: 21902951, PMCid: PMC3134705
Raja SG, Sarang Z. Endoscopic vein harvesting: technique, outcomes, concerns & controversies. Journal of
thoracic disease. 2013;5(Suppl 6):S630.
Rao C, Aziz O, Deeba S, Chow A, Jones C, Ni Z, et al. Is minimally invasive harvesting of the great
saphenous vein for coronary artery bypass surgery a cost-effective technique? The Journal of thoracic and
cardiovascular surgery. 2008;135(4):809-15. Doi: 10.1016/j.jtcvs.2007.09.042, PMid: 18374760
Coppoolse R, Rees W, Krech R, Hufnagel M, Seufert K, Warnecke H. Routine minimal invasive vein
harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients.
European Journal of Cardio-Thoracic Surgery. 1999;16(Supplement 2):S61-S6.
Raja SG, Siddiqui H, Ilsley CD, Amrani M. In-hospital outcomes of off-pump multivessel total arterial and
conventional coronary artery bypass grafting: single surgeon, single center experience. The Annals of
thoracic surgery. 2009;88(1):47-52. Doi: 10.1016/j.athoracsur.2009.04.013, PMid: 19559187
Egol K, Koval K, Zuckerman J, Koval K. Handbook of fractures. Fourth ed. Philadelphia: Wolters
Kluwer/Lippincott Williams & Wilkins Health; 2010 March 29, 2010.
Deppe A-C, Liakopoulos OJ, Choi Y-H, Slottosch I, Kuhn EW, Scherner M, et al. Endoscopic vein
harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients.
Journal of Surgical Research. 2013;180(1):114-24. Doi: 10.1016/j.jss.2012.11.013, PMid: 23218736
Andreasen JJ, Nekrasas V, Dethlefsen C. Endoscopic vs open saphenous vein harvest for coronary artery
bypass grafting: a prospective randomized trial. European Journal of Cardio-Thoracic Surgery.
;34(2):384-9. Doi: 10.1016/j.ejcts.2008.04.028, PMid: 18508277
Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, et al. Endoscopic versus
open vein-graft harvesting in coronary-artery bypass surgery. New England Journal of Medicine.
;361(3):235-44. Doi: 10.1056/NEJMoa0900708, PMid: 19605828
Bonde P, Graham A, MacGowan S, editors. Endoscopic vein harvest: early results of a prospective trial
with open vein harvest. The heart surgery forum; 2002.
Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, et al. A prospective randomized trial
of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. The
Journal of Thoracic and Cardiovascular Surgery. 2002;123(2):204-12. Doi: 10.1067/mtc.2002.118682,
PMid: 11828277
Patel AN, Hebeler RF, Hamman BL, Hunnicutt C, Williams M, Liu L, et al. Prospective analysis of
endoscopic vein harvesting. The American journal of surgery. 2001;182(6):716-9. Doi: 10.1016/S0002- 9610(01)00824-8
Cheng D, Allen K, Cohn W, Connolly M, Edgerton J, Falk V, et al. Endoscopic vascular harvest in
coronary artery bypass grafting surgery: a meta-analysis of randomized trials and controlled trials.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2005;1(2):61-74. Doi:
1097/01.gim.0000196316.48694.41
Athanasiou T, Aziz O, Skapinakis P, Perunovic B, Hart J, Crossman M-C, et al. Leg wound infection after
coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein
harvesting. The Annals of thoracic surgery. 2003;76(6):2141-6. Doi: 10.1016/S0003-4975(03)01435-8
Sastry P, Rivinius R, Harvey R, Parker RA, Rahm A-K, Thomas D, et al. The influence of endoscopic vein
harvesting on outcomes after coronary bypass grafting: a meta-analysis of 267 525 patients. European
Journal of Cardio-Thoracic Surgery. 2013;44(6):980-9. Doi: 10.1093/ejcts/ezt121, PMid: 23515174
Allen KB, Heimansohn DA, Robison RJ, Schier JJ, Griffith GL, Fitzgerald EB, editors. Influence of
endoscopic versus traditional saphenectomy on event-free survival: five-year follow-up of a prospective
randomized trial. The heart surgery forum; 2003: Carden Jennings.
Reed JF. Leg wound infections following greater saphenous vein harvesting: minimally invasive vein
harvesting versus conventional vein harvesting. The international journal of lower extremity wounds.
;7(4):210-9. Doi: 10.1177/1534734608324172, PMid: 18815201
Hussaini BE, Lu XG, Wolfe JA, Thatte HS. Evaluation of endoscopic vein extraction on structural and
functional viability of saphenous vein endothelium. J Cardiothorac Surg. 2011;6:82. Doi: 10.1186/1749- 8090-6-82, PMid: 21663646, PMCid: PMC3125322
Wang H, Wu H, Jiang H, Wang Z, Potapov E, Stepanenko A. Initial experience with endoscopic saphenous
vein harvesting for coronary artery bypass grafting in Chinese patients. The heart surgery forum. 2011
Oct;14(5):E291-6.
Andreasen JJ, Vadmann H, Oddershede L, Tilsted HH, Frøkjær JB, Jensen SE Decreased patency rates
following endoscopic vein harvest in coronary artery bypass surgery.. Scand Cardiovasc J. 2015 Jul 1:1-7.
[Epub ahead of print] PMID: 26053411
Van Diepen S1, Brennan JM, Hafley GE, Reyes EM, Allen KB, Ferguson TB, Peterson ED, Williams JB,
Gibson CM, Mack MJ, Kouchoukos NT, Alexander JH, Lopes RD.Endoscopic harvesting device type and
outcomes in patients undergoing coronary artery bypass surgery.Ann Surg. 2014 Aug;260(2):402, doi:
1097/SLA.0000000000000377. PMID: 24368640
Kim do Y1, Song H, Kim HW, Jo GH1, Kang J. Early Outcomes of Endoscopic Vein Harvesting during
the Initial Learning Period. Korean J Thorac Cardiovasc Surg. 2015 Jun;48(3):174-9. doi:
5090/kjtcs.2015.48.3.174. Epub 2015 Jun 5. PMID: 26078923
Raja SG, Sarang Z. Endoscopic vein harvesting: technique, outcomes, concerns & controversies.J Thorac
Dis. 2013 Nov;5 Suppl 6:S630-7. doi: 10.3978/j.issn.2072-1439.2013.10.01. Review. PMID: 24251019
Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J,Falk V,et al 2014 ESC/EACTS Guidelines on
myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of
Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with
the special contribution of the European Association of Percutaneous Cardiovascular Interventions
(EAPCI).Eur J Cardiothorac Surg. 2014 Oct;46(4):517-92. doi: 10.1093/ejcts/ezu366. Epub 2014 Aug 29.
PMID: 25173601.
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