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Kay M, Abouelela Y, Raaj S, Krishnamoorthy B. Does the experience of the endoscopic vein harvester matter to the quality of the vein conduit: A critical thematic literature review. J Perioper Pract 2025; 35:171-182. [PMID: 39435993 DOI: 10.1177/17504589241288512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Abstract
Coronary artery bypass graft surgery remains the golden standard surgical option for multiple vessel disease. Harvesting the long saphenous vein using endoscopic vein harvesting requires advanced surgical skills dexterity, but the lack of a national standardised training programme allows for variance in the learning curve and the quality of the vein during the learning cycle is unknown. A search of bibliographic databases: CINHAL Plus, Embase, Pubmed and the Cochrane register for randomised controlled trials identified 11 articles eligible for review. The themes emerging were learning curve-associated injuries to the long saphenous vein, intimal wall remodelling of the long saphenous vein and incidence of graft patency rates. Harvesting practitioners with less than 100 cases of experience inflict more conduit injuries leading to endothelial remodelling and narrowed vein grafts at the six-month point resulting in lumen loss. Practitioners with more than 100 cases demonstrated reduced learning curve-related injuries on the conduit. Adopting a formalised structured training programme such as the Manchester Endoscopic Learning Tool has shown to reduce endothelial injury to the long saphenous vein minimising early vein graft failure during the learning cycle.
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Affiliation(s)
- Michael Kay
- Department of Cardiothoracic Surgery, The Essex Cardiothoracic Centre, Basildon, UK
| | - Youssef Abouelela
- Department of Cardiothoracic Surgery, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sam Raaj
- Faculty of Medicine, Imperial College School of Medicine, London, UK
| | - Bhuvaneswari Krishnamoorthy
- School of Nursing & Midwifery, The University of Salford, Manchester, UK
- Department of Cardiothoracic Surgery, Manchester NHS Foundation Trust, Manchester, UK
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Sampath HK, Lee TJH, Cher CE, Liang S, Cheong OO, Kofidis T, Vitaly S, Sazzad F. A Comprehensive Clinical Outcome Analysis of Endoscopic Vessel Harvesting for Coronary Artery Bypass Surgery. J Clin Med 2024; 13:3405. [PMID: 38929933 PMCID: PMC11204017 DOI: 10.3390/jcm13123405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The long saphenous vein is routinely used for coronary bypass graft (CABG) surgery, and two primary techniques are commonly utilized: endoscopic vessel harvesting (EVH) and open vessel harvesting (OVH). The aim of this study was to compare the clinical outcomes of the EVH and OVH techniques used for CABG within the confines of a tertiary hospital. Methods: The clinical data of all patients subjected to either EVH or OVH for CABG surgery between 2014 and 2018 were retrospectively analyzed. Statistical analysis was performed to discern variations in the rates of postoperative complications between EVH and OVH. Results: A cohort of 1884 individuals were included in this study, 75.3% of whom underwent EVH. Notably, the incidence of postoperative leg wound complications was significantly different between the patients who underwent OVH and the patients who underwent EVH, with incidence rates of 18.6% and 32%, respectively (p < 0.001). Leg wound complications (p < 0.001; OR 1.946; 95% CI 1.528-2.477) and leg wound infections (p = 0.050, OR 1.517, 95% CI 0.999-2.303) were significantly associated with OVH. Moreover, leg wound hematoma (p = 0.039, OR = 0.402, 95% CI = 0.169-0.957) and EVH were strongly associated. Conclusions: The large sample of patients and the inclusion of a range of Asian ethnic groups provided notable insights into postoperative complications related to different modalities. EVH was associated with a lower incidence of postoperative leg wound complications, which suggests that EVH is a better modality for those undergoing CABG surgery.
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Affiliation(s)
- Hari Kumar Sampath
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
| | - Terence Ji Hui Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Chua E. Cher
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Shen Liang
- Biostatistics Unit (BSU), Department of Medicine, National University of Singapore, Singapore 117549, Singapore
| | - Ooi Oon Cheong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
- Centre for Translational Medicine (MD6), National University of Singapore, 14 Medical Drive, Level-8 (South), Singapore 117599, Singapore
| | - Sorokin Vitaly
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
- Centre for Translational Medicine (MD6), National University of Singapore, 14 Medical Drive, Level-8 (South), Singapore 117599, Singapore
| | - Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
- Centre for Translational Medicine (MD6), National University of Singapore, 14 Medical Drive, Level-8 (South), Singapore 117599, Singapore
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Zivkovic I, Krasic S, Stankovic M, Milacic P, Milutinovic A, Zdravkovic D, Tabakovic Z, Peric M, Krstic M, Bojic M, Milic D, Micovic S. Influence of Three Different Surgical Techniques on Microscopic Damage of Saphenous Vein Grafts-A Randomized Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020217. [PMID: 36837419 PMCID: PMC9962261 DOI: 10.3390/medicina59020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023]
Abstract
Background and Objectives: The saphenous vein is one of the most common used grafts (SVG) for surgical revascularization. The mechanism of the SVGs occlusion is still unknown. Surgical preparation techniques have an important role in the early and late graft occlusion. Our study analyzed the influence of the three different surgical techniques on the histological and immunohistochemical characteristics of the vein grafts. Methods: Between June 2019 and December 2020, 83 patients who underwent surgical revascularization were prospectively randomly assigned to one of the three groups, according to saphenous vein graft harvesting (conventional (CVH), no-touch (NT) and endoscopic (EVH)) technique. The vein graft samples were sent on the histological (hematoxylin-eosin staining) and immunohistochemical (CD31, Factor VIII, Caveolin and eNOS) examinations. Results: The CVH, NT, and EVH groups included 27 patients (mean age 67.66 ± 5.6), 31 patients (mean age 66.5 ± 7.4) and 25 patients (mean age 66 ± 5.5), respectively. Hematoxylin-eosin staining revealed a lower grade of microstructural vein damage in the NT group (2, IQR 1-2) in comparison with CVH and EVH (3, IQR 2-4), (4, IQR 2-4) respectively (p < 0.001). Immunohistochemical examination revealed a high grade of staining in the NT group compared to the CVH and EVH group (CD 31 antibody p = 0.02, FVIII, p < 0.001, Caveolin, p = 0.001, and eNOS, p = 0.003). Conclusion: The best preservation of the structural vein integrity was in the NT group, while the lowest rate of leg wound complication was in the EVH group. These facts increase the interest in developing and implementing the endoscopic no-touch technique.
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Affiliation(s)
- Igor Zivkovic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-6-2100-9619
| | - Stasa Krasic
- Cardiology Department, Mother and Child Health Care Institute, 11000 Belgrade, Serbia
| | - Milica Stankovic
- Center for Pathology and Pathological Anatomy, Clinical Center of Niš, 18000 Niš, Serbia
| | - Petar Milacic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Djordje Zdravkovic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Zoran Tabakovic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Miodrag Peric
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Miljan Krstic
- Center for Pathology and Pathological Anatomy, Clinical Center of Niš, 18000 Niš, Serbia
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Milovan Bojic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragan Milic
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia
- Cardiac Surgery Department, Clinical Center of Niš, 18000 Niš, Serbia
| | - Slobodan Micovic
- Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Spadaccio C, Nenna A, Candura D, Rose D, Moscarelli M, Al-Attar N, Sutherland F. Total arterial coronary artery bypass grafting in patients with preoperative anemia. J Card Surg 2022; 37:1528-1536. [PMID: 35324020 DOI: 10.1111/jocs.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Blood transfusions after coronary artery bypass grafting (CABG) has been associated to adverse outcomes, especially in anemic patients. However, little is known about the influence of the modality of revascularization. Total arterial revascularization (TAR) was shown to reduce postoperative transfusion when compared to saphenous vein-based (SV)-CABG (LIMA plus one/more SV grafts). We, therefore, aimed to investigate the impact of TAR-CABG versus SV-CABG on blood products use and perioperative outcomes in patients with preoperative anemia, normally at higher risk for postoperative transfusions. METHODS From a cohort of 936 patients with mild preoperative anemia undergoing primary elective on-pump CABG, 166 matched pairs of patients undergoing either TAR- or SV-CABG were obtained. Anemia was defined as hemoglobin level <13 g/dl for men and <12 g/dl for women. The primary endpoint was the evaluation of red packed cells (RPC) use over the entire hospital stay. RESULTS TAR patients showed significantly reduced RPC usage compared with SV (mean difference 0.45 units). TAR patients had a reduced intubation time (mean difference 7.6 h) and were discharged 1.24 days earlier than SV patients. Pneumonia and acute kidney injury were doubled among SV patients. Adjusted regression showed that TAR technique is a predictor of reduced RPC unit use regardless of age and EuroSCORE II (odds ratio: 0.63, p < .01). CONCLUSION Patients with preoperative anemia might benefit from TAR regardless of age or calculated operative risk. TAR-CABG was associated to reduced postoperative use of blood products and postoperative length of stay in comparison with SV-CABG in this subset of patients.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK.,Cardiac Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Nenna
- Cardiac Surgery Department, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Dario Candura
- Cardiac Surgery Department, Leiden University Medical Centrum, Leiden, The Netherlands
| | - David Rose
- Cardiac Surgery Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital (GVM), Cotignola, Ravenna, Italy
| | - Nawwar Al-Attar
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK
| | - Fraser Sutherland
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK
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Hibino M, Dhingra NK, Verma S. Increased patency with comparable mortality and revascularization risk: Is the case for no-touch vein harvesting open and shut? J Card Surg 2021; 36:4376-4377. [PMID: 34477262 DOI: 10.1111/jocs.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada
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