Surgical Techniques and Short-term Outcomes of Endoscopic Saphenous Vein Harvesting for Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WUHai-bo , XUShu , WANGQiang , DUYe-jun , ZHAOKe-yan ,  WANGHui-shan

Department of Cardiovascular Surgery, The General Hospital of Shenyang Military Region, Shenyang 110016, P. R. China;

Corresponding author：

WANGHui-shan, Email: huishanwang@hotmail.com

Keywords：

Coronary artery bypass grafting; Endoscopy; Great saphenous vein

DOI：

10.7507/1007-4848.20150017

Video：

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Objective To investigate short-term outcomes and surgical techniques of endoscopic saphenous vein harvesting (ESVH) for coronary artery bypass grafting (CABG). Methods Clinical data of 554 patients undergoing CABG with ESVH in General Hospital of Shenyang Military between July 2009 and August 2013 were retrospectively analyzed. There were 372 male and 182 female patients with their age of 38-84(61.3±9.0) years. Clinical outcomes, postoperative lower extremity pain and edema, wound infection and healing were analyzed. Results During ESVH, 13 patients with very little subcutaneous fat received transition to skin bridge technology or partially open incision. Average number of harvested vein grafts was 1-4 (2.0±0.6), and the quality of the vein grafts was satisfactory. Postoperative lower extremity pain and edema were significantly reduced, and there was no delayed wound healing or infection. Seven patients died postoperatively, including 2 patients with perioperative myocardial infarction, 2 patients with pneumonia, 1 patient with ventricular fibrillation, 1 patient with massive cerebral infarction, and 1 patient with multiple organ dysfunction syndrome. A total of 452 patients were followed up for 120-1 460 (742.6±188.5) days. There was no late death or reintervention during follow-up. Conclusion ESVH is a safe and efficacious procedure with less postoperative lower extremity pain and edema, satisfactory vein graft quality, better postoperative recovery and cosmetic results, compared with traditional fully or intermittently open wound for saphenous vein harvesting.

Citation： WUHai-bo, XUShu, WANGQiang, DUYe-jun, ZHAOKe-yan, WANGHui-shan. Surgical Techniques and Short-term Outcomes of Endoscopic Saphenous Vein Harvesting for Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 57-60. doi: 10.7507/1007-4848.20150017 Copy

1.	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(Phila), 2005, 1(2):51-60.
2.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery:summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol, 2004, 44(5):e213-e310.
3.	Allen KB, Griffith GL, Heimansohn DA, et al. Endoscopic versus traditional saphenous vein harvesting:a prospective, randomized trial. Ann Thorac Surg, 1998, 66(1):26-31.
4.	Lumsden AB, Eaves FF 3rd, Ofenloch JC, et al. Subcutaneous, video-assisted saphenous vein harvest:report of the first 30 cases. Cardiovasc Surg, 1996, 4(6):771-776.
5.	Nickum CW. Endoscopic vessel harvesting in coronary artery bypass graft surgery. JAAPA, 2005, 18(11):40, 42, 44, 51-53.
6.	Vaidyanathan KR, Sankar MN, Cherian KM. Endoscopic vs conventional vein harvesting:a prospective analysis. Asian Cardiovasc Thorac Ann, 2008, 16(2):134-138.
7.	Brown EN, Kon ZN, Tran R, et al. Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins. J Thorac Cardiovasc Surg, 2007, 134(5):1259-1265.
8.	Zilla P, von Oppell U, Deutsch M. The endothelium:a key to the future. J Card Surg, 1993, 8(1):32-60.
9.	Verrier ED, Boyle EM. Endothelial cell injury in cardiovascular surgery. Ann Thorac Surg, 1996, 62(3):915-922.
10.	Sellke FW, Boyle EM, Verrier ED. Endothelial cell injury in cardiovascular surgery:the pathophysiology of vasomotor dysfunction. Ann Thorac Surg, 1996, 62(4):1222-1228.
11.	Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open veingraft harvesting in cononary-artery bypass surgery. New Engl J Med, 2009, 361(3):235-244.
12.	Rousou LJ, Taylor KB, Lu XG, et al. Saphenous vein conduits harvested by endoscopic technique exhibit structural and functional damage. Ann Thorac Surg, 2009, 87(1):62-70.
13.	张晓慎, 郭惠明, 谢斌, 等. 冠状动脉旁路移植术中内窥镜采集大隐静脉200 例经验总结. 岭南心血管病杂志, 2013, 19(3):133-136.
14.	Wang H, Wu H, Jiang H, et al. Initial experience with endoscopic saphenous vein harvesting for coronary artery bypass grafting in Chinese patients. Heart Surg Forum, 2011, 14(5):E291-E296.
15.	Rang HP, Dale MM, Ritter JM, et al. Hemostasis and thrombosis. Pharmacology. New York:Churchill Livingstone, 1995.331-350.
16.	Higami T, Kozawa S, Asada T, et al. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg, 2000, 70(1):307-308.
17.	Higami T, Maruo A, Yamashita T, et al. Histologic and physiologic evaluation of skeletonized internal thoracic artery harvesting with an ultrasonic scalpel. J Thorac Cardiovasc Surg, 2000, 120(6):1142-1147.
18.	王东文, 张永, 肖志斌, 等. 内窥镜采集大隐静脉联合直视采集桡动脉在冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2011, 18(3):260-262.
19.	王学宁, William Wang, 张顺业, 等. 内窥镜大隐静脉采集术在冠状动脉旁路移植术中的应用. 中西医结合心脑血管病杂志, 2011, 9(1):28-30.
20.	吴松, 张喆, 刘强, 等. 内窥镜血管采集系统和间断小切口获取大隐静脉在冠状动脉旁路移植术的应用研究. 中国微创外科杂志, 2013, 13(1):15-17.

1. 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(Phila), 2005, 1(2):51-60.
2. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery:summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol, 2004, 44(5):e213-e310.
3. Allen KB, Griffith GL, Heimansohn DA, et al. Endoscopic versus traditional saphenous vein harvesting:a prospective, randomized trial. Ann Thorac Surg, 1998, 66(1):26-31.
4. Lumsden AB, Eaves FF 3rd, Ofenloch JC, et al. Subcutaneous, video-assisted saphenous vein harvest:report of the first 30 cases. Cardiovasc Surg, 1996, 4(6):771-776.
5. Nickum CW. Endoscopic vessel harvesting in coronary artery bypass graft surgery. JAAPA, 2005, 18(11):40, 42, 44, 51-53.
6. Vaidyanathan KR, Sankar MN, Cherian KM. Endoscopic vs conventional vein harvesting:a prospective analysis. Asian Cardiovasc Thorac Ann, 2008, 16(2):134-138.
7. Brown EN, Kon ZN, Tran R, et al. Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins. J Thorac Cardiovasc Surg, 2007, 134(5):1259-1265.
8. Zilla P, von Oppell U, Deutsch M. The endothelium:a key to the future. J Card Surg, 1993, 8(1):32-60.
9. Verrier ED, Boyle EM. Endothelial cell injury in cardiovascular surgery. Ann Thorac Surg, 1996, 62(3):915-922.
10. Sellke FW, Boyle EM, Verrier ED. Endothelial cell injury in cardiovascular surgery:the pathophysiology of vasomotor dysfunction. Ann Thorac Surg, 1996, 62(4):1222-1228.
11. Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open veingraft harvesting in cononary-artery bypass surgery. New Engl J Med, 2009, 361(3):235-244.
12. Rousou LJ, Taylor KB, Lu XG, et al. Saphenous vein conduits harvested by endoscopic technique exhibit structural and functional damage. Ann Thorac Surg, 2009, 87(1):62-70.
13. 张晓慎, 郭惠明, 谢斌, 等. 冠状动脉旁路移植术中内窥镜采集大隐静脉200 例经验总结. 岭南心血管病杂志, 2013, 19(3):133-136.
14. Wang H, Wu H, Jiang H, et al. Initial experience with endoscopic saphenous vein harvesting for coronary artery bypass grafting in Chinese patients. Heart Surg Forum, 2011, 14(5):E291-E296.
15. Rang HP, Dale MM, Ritter JM, et al. Hemostasis and thrombosis. Pharmacology. New York:Churchill Livingstone, 1995.331-350.
16. Higami T, Kozawa S, Asada T, et al. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg, 2000, 70(1):307-308.
17. Higami T, Maruo A, Yamashita T, et al. Histologic and physiologic evaluation of skeletonized internal thoracic artery harvesting with an ultrasonic scalpel. J Thorac Cardiovasc Surg, 2000, 120(6):1142-1147.
18. 王东文, 张永, 肖志斌, 等. 内窥镜采集大隐静脉联合直视采集桡动脉在冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2011, 18(3):260-262.
19. 王学宁, William Wang, 张顺业, 等. 内窥镜大隐静脉采集术在冠状动脉旁路移植术中的应用. 中西医结合心脑血管病杂志, 2011, 9(1):28-30.
20. 吴松, 张喆, 刘强, 等. 内窥镜血管采集系统和间断小切口获取大隐静脉在冠状动脉旁路移植术的应用研究. 中国微创外科杂志, 2013, 13(1):15-17.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Techniques and Short-term Outcomes of Endoscopic Saphenous Vein Harvesting for Coronary Artery Bypass Grafting

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