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Nakamura R, Honda K, Kunimoto H, Fujimoto T, Agematsu K, Nishimura Y. Impact of Graft Velocity on Saphenous Vein Graft Atherosclerosis after Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2024; 30:23-00066. [PMID: 37468261 PMCID: PMC10902658 DOI: 10.5761/atcs.oa.23-00066] [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] [Received: 04/16/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Saphenous vein grafts (SVGs) sometimes occur as vein graft stenosis or failure in coronary artery bypass grafting. The purpose of this study was to detect the factors affecting vein graft atherosclerosis. METHODS We performed two analysis. In the first analysis, we enrolled 120 grafts using conventionally harvested saphenous vein graft (C-SVG) and followed-up with multiple coronary computed tomography angiography (CCTA). We examined the factors that contribute to the graft atherosclerosis defined by graft failure at subsequent CCTA or substantial progression of graft stenosis (a decrease of ≥0.6 mm in diameter). In the second analysis, 66 grafts using no-touch harvested saphenous vein graft (N-SVG) were compared with those in the first analysis using C-SVG, focusing on the differences in intraoperative factors using propensity score-matched analysis. RESULTS In the first analysis, graft atherosclerosis+ group comprised 27 grafts, which had a larger SVG diameter, lower graft velocity, and higher graft/native ratio in diameter than the graft atherosclerosis- group. In the multivariable analysis, slow graft velocity and graft/native ≥2 in diameter were independently associated with the graft atherosclerosis. In the second analysis, the N-SVG group had a much greater graft velocity than the C-SVG group. CONCLUSION Lower graft velocity and higher graft/native ratio in diameter were associated with the graft atherosclerosis. The N-SVG group had increased graft velocity, which may contribute to prevent the graft atherosclerosis.(Trial registration: UMIN Clinical Trial Registry no. UMIN000050482. Registered 3 March 2023, retrospectively registered.).
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Affiliation(s)
- Ryo Nakamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Takahiro Fujimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kota Agematsu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
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Yoshino K, Kikuchi K, Tamaki R, Sakai H, Hara R, Sai Y, Ito J, Abe K. A Novel Technique of No-Touch Endoscopic Saphenous Vein Harvesting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:589-591. [PMID: 37994624 DOI: 10.1177/15569845231210299] [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: 11/24/2023]
Abstract
No-touch saphenous vein harvesting is considered an ideal procedure for harvesting good-quality veins, whereas endoscopic vein harvesting (EVH) is considered ideal for decreasing wound complications. The no-touch EVH (NT-EVH) technique, which was developed in 2018, is one of the best vein-harvesting procedures. We have improved this method in several aspects since our initial experience. Herein, we present the details of this technique.
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Affiliation(s)
- Kunihiko Yoshino
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Keita Kikuchi
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroki Sakai
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Ryota Hara
- Department of Cardiovascular Surgery, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Youshun Sai
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Joji Ito
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, Itabashi Chuo Medical Center, Tokyo, Japan
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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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Kim HH, Kim JH, Lee SH, Yoo KJ, Youn YN. Transit-time flow measurement and outcomes in coronary artery bypass graft patients. Semin Thorac Cardiovasc Surg 2022; 35:217-227. [DOI: 10.1053/j.semtcvs.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
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Sakurai H, Someya T, Yamamoto S, Kasahara I, Kuroki H, Shirai T. Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:56-63. [PMID: 35225063 DOI: 10.1177/15569845221074463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Saphenous vein grafts (SVGs) are widely used as bypass conduits in coronary artery bypass grafting. Compared with the conventional technique, the "no-touch" technique, wherein the saphenous veins are harvested with the surrounding tissue, may improve SVG patency; however, there are concerns regarding wound complications. To address this issue, we describe our novel no-touch technique with separate skin incisions using a long-shafted ultrasonic scalpel and report the clinical outcomes. METHODS We enrolled 66 male patients who underwent isolated coronary artery bypass grafting between April 2016 and April 2021. There were 30 and 36 patients treated using our no-touch technique and the conventional technique, respectively. The participants underwent coronary angiography before discharge and were followed clinically. SVG samples were taken for pathological examination. RESULTS SVGs harvested using our no-touch technique displayed preservation of the vessel wall structure and surrounding tissues. Our no-touch technique demonstrated no inferiority in patency compared with the conventional technique, and there was no SVG occlusion in the no-touch group. The frequency of leg wound complications was higher in the no-touch group than the conventional group, but no surgical site infections and severe complications occurred in the no-touch group. CONCLUSIONS SVGs harvested using our novel no-touch technique had similar pathological characteristics to those harvested using the original no-touch technique reported previously. Our no-touch technique maintained SVG patency and caused no severe wound complications. However, a large-scale, longitudinal study is required to accurately assess the clinical outcomes of our no-touch technique.
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Affiliation(s)
- Hironobu Sakurai
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Takeshi Someya
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Satoshi Yamamoto
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Ichiro Kasahara
- Department of Diagnostic Pathology, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Hidehito Kuroki
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
| | - Toshizumi Shirai
- Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan
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Zhao TY, Bu JQ, Gu JJ, Liu Y, Zhang WL, Chen ZY. The Short-Term Patency Rate of a Saphenous Vein Bridge Using the No-Touch Technique in off-Pump Coronary Artery Bypass Grafting in Vein Harvesting. Int J Gen Med 2021; 14:2281-2288. [PMID: 34113157 PMCID: PMC8184136 DOI: 10.2147/ijgm.s311249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to examine the short-term effect of the no-touch technique on the patency rate of a great saphenous vein (GSV) bridge used during off-pump coronary artery bypass grafting (OPCABG). Methods Between June 2018 and September 2020, 140 patients undergoing OPCABG, with grafts obtained from the GSV using the "no-touch" technique or the left internal mammary artery (LIMA), were enrolled in this study. The early clinical results and short-term patency rate of the OPCABG were evaluated at a three-month follow-up by comparing the patency rate of the LIMA bridge and the GSV bridge obtained by the no-touch technique. This study also analyzed the impacts of the postoperative complications of the lower limbs and the distribution area of diseased vessels on the patency rate of a GSV bridge obtained by the no-touch technique at an early stage. Results No perioperative death or adverse cardiovascular or cerebrovascular events occurred in the 140 patients undergoing OPCABG. The difference in the early patency rate between the GSV bridge obtained by the no-touch technique and the LIMA bridge was not statistically significant (95.9% vs 97.1%, p = 0.501). There was no significant difference in the patency rate between an end-to-side anastomosed venous bridge and a LIMA bridge (95.0% [248/261] vs 97.1% [136/140], p = 0.314). The overall patency rate of a no-touch vein bridge in the right coronary artery region was lower than it was in the left coronary artery region (93.8% [165/176] vs 97.9% [183/187], p = 0.049). Conclusion The no-touch technique may improve the early patency rate of a GSV bridge, and its effect is similar to that of a LIMA bridge.
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Affiliation(s)
- Teng-Yue Zhao
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Ji-Qiang Bu
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Jian-Jun Gu
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Yu Liu
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Wen-Li Zhang
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Zi-Ying Chen
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
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