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Li P, Chang Y, Song J. Advances in preclinical surgical therapy of cardiovascular diseases. Int J Surg 2024; 110:4965-4975. [PMID: 38701509 PMCID: PMC11326035 DOI: 10.1097/js9.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Cardiovascular disease is the most common cause of death worldwide, resulting in millions of deaths annually. Currently, there are still some deficiencies in the treatment of cardiovascular diseases. Innovative surgical treatments are currently being developed and tested in response to this situation. Large animal models, which are similar to humans in terms of anatomy, physiology, and genetics, play a crucial role in connecting basic research and clinical applications. This article reviews recent preclinical studies and the latest clinical advancements in cardiovascular disease based on large animal models, with a focus on targeted delivery, neural regulation, cardiac remodeling, and hemodynamic regulation. It provides new perspectives and ideas for clinical translation and offers new methods for clinical treatment.
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Affiliation(s)
- Peiyuan Li
- Department of Cardiac Surgery, Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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2
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Gaudino M, Bakaeen FG, Sandner S, Aldea GS, Arai H, Chikwe J, Firestone S, Fremes SE, Gomes WJ, Bong-Kim K, Kisson K, Kurlansky P, Lawton J, Navia D, Puskas JD, Ruel M, Sabik JF, Schwann TA, Taggart DP, Tatoulis J, Wyler von Ballmoos M. Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS). J Thorac Cardiovasc Surg 2023; 166:1099-1114. [PMID: 37542480 DOI: 10.1016/j.jtcvs.2023.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | | | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Ki Bong-Kim
- Cardiovascular Center, Myong-ji Hospital, Gyeong-gi-do, Republic of Korea
| | | | - Paul Kurlansky
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, NY
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Daniel Navia
- Department of Cardiac Surgery, ICBA Instituto Cardiovascular, Buenos Aires, Argentina
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - David P Taggart
- Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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3
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Gaudino M, Bakaeen FG, Sandner S, Aldea GS, Arai H, Chikwe J, Firestone S, Fremes SE, Gomes WJ, Bong-Kim K, Kisson K, Kurlansky P, Lawton J, Navia D, Puskas JD, Ruel M, Sabik JF, Schwann TA, Taggart DP, Tatoulis J, Wyler von Ballmoos M. Expert Systematic Review on the Choice of Conduits for Coronary Artery Bypass Grafting: Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2023; 116:659-674. [PMID: 37542509 DOI: 10.1016/j.athoracsur.2023.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Ki Bong-Kim
- Cardiovascular Center, Myong-ji Hospital, Gyeong-gi-do, Republic of Korea
| | - Kalie Kisson
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Paul Kurlansky
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Navia
- Department of Cardiac Surgery, ICBA Instituto Cardiovascular, Buenos Aires, Argentina
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, New York
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thomas A Schwann
- Division of Cardiac Surgery, Baystate Health, Springfield, Massachusetts
| | - David P Taggart
- Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Moritz Wyler von Ballmoos
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
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4
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Gaudino M, Bakaeen FG, Sandner S, Aldea GS, Arai H, Chikwe J, Firestone S, Fremes SE, Gomes WJ, Bong-Kim K, Kisson K, Kurlansky P, Lawton J, Navia D, Puskas JD, Ruel M, Sabik JF, Schwann TA, Taggart DP, Tatoulis J, Wyler von Ballmoos M. Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS). Eur J Cardiothorac Surg 2023; 64:ezad163. [PMID: 37535847 DOI: 10.1093/ejcts/ezad163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 08/05/2023] Open
Abstract
PREAMBLE The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS).
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Ki Bong-Kim
- Cardiovascular Center, Myong-ji Hospital, Gyeong-gi-do, Republic of Korea
| | - Kalie Kisson
- The Society of Thoracic Surgeons, Chicago, IL, USA
| | - Paul Kurlansky
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, NY, USA
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Navia
- Department of Cardiac Surgery, ICBA Instituto Cardiovascular, Buenos Aires, Argentina
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY, USA
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Thomas A Schwann
- Division of Cardiac Surgery, Baystate Health, Springfield, MA, USA
| | - David P Taggart
- Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Moritz Wyler von Ballmoos
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Ono M, Kageyama S, O’Leary N, El-Kurdi MS, Reinöhl J, Solien E, Bianco RW, Doss M, Meuris B, Virmani R, Cox M, Onuma Y, Serruys PW. 1-Year Patency of Biorestorative Polymeric Coronary Artery Bypass Grafts in an Ovine Model. JACC. BASIC TO TRANSLATIONAL SCIENCE 2022; 8:19-34. [PMID: 36777172 PMCID: PMC9911320 DOI: 10.1016/j.jacbts.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
Many attempts have been made to inhibit or counteract saphenous vein graft (SVG) failure modes; however, only external support for SVGs has gained momentum in clinical utility. This study revealed the feasibility of implantation, and showed good patency out to 12 months of the novel biorestorative graft, in a challenging ovine coronary artery bypass graft model. This finding could trigger the first-in-man trial of using the novel material instead of SVG. We believe that, eventually, this novel biorestorative bypass graft can be one of the options for coronary artery bypass graft patients who have difficulty harvesting SVG.
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Key Words
- CABG, coronary artery bypass grafting
- CPB, cardiopulmonary bypass
- IH, intimal hyperplasia
- LAD, left anterior descending artery
- OCT, optical coherence tomography
- QCA, quantitative coronary angiography
- QFR, quantitative flow ratio
- RVG, restorative vascular graft
- SVG, saphenous vein graft
- coronary artery bypass graft
- coronary artery disease
- coronary revascularization
- ePTFE, expanded polytetrafluoroethylene
- polymeric bypass graft
- preclinical model
- quantitative flow ratio
- restorative vascular graft
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Affiliation(s)
- Masafumi Ono
- Amsterdam Universitair Medische Centra, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Neil O’Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | | | - Eric Solien
- American Preclinical Services, LLC, Minneapolis, Minnesota, USA
| | - Richard W. Bianco
- Experimental Surgical Services, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mirko Doss
- Department of Cardiac Surgery, Helios Clinic, Siegburg, Germany
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium
| | - Renu Virmani
- CVPath Institute, Inc, Gaithersburg, Maryland, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
- Address for correspondence: Dr Patrick W. Serruys, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.
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Dallan LRP, Dallan LAO, Lisboa LAF, Mejia OAV, Platania F, Rodrigues RDC, Dallan LAP, Jatene FB. Transit‐time flow measurement parameters after protamine infusion in CABG surgeries. J Card Surg 2022; 37:3492-3506. [DOI: 10.1111/jocs.16948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Luis Roberto P. Dallan
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Luis Alberto O. Dallan
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Luiz Augusto F. Lisboa
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Omar A. V. Mejia
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Fernando Platania
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Renan de Carvalho Rodrigues
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
| | - Luis Augusto P. Dallan
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute University Hospitals Cleveland Medical Center Cleveland Ohio USA
| | - Fabio B. Jatene
- Department of Cardiovascular Surgery, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina Universidade de Sao Paulo São Paulo Brazil
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Sandner SE, Donovan TJ, Edelstein S, Puskas JD, Angleitner P, Krasopoulos G, Channon K, Gehrig T, Rajakaruna C, Ladyshenskij L, De Silva R, Bonaros N, Bolotin G, Jacobs S, Thielmann M, Choi YH, Ohri S, Lipey A, Friedrich I, Taggart DP. Effects of the harvesting technique and external stenting on progression of vein graft disease 2 years after coronary artery bypass. Eur J Cardiothorac Surg 2022; 62:ezac045. [PMID: 35312782 DOI: 10.1093/ejcts/ezac045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. METHODS Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. RESULTS Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. CONCLUSIONS A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting.
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Affiliation(s)
- Sigrid E Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | | | | | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, USA
| | | | - George Krasopoulos
- Department of Cardiac Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Thomas Gehrig
- Herzzentrum Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany
| | - Cha Rajakaruna
- Department of Cardiothoracic Surgery, University Hospitals Bristol, UK
| | - Leonid Ladyshenskij
- Department of Cardiothoracic Surgery, Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Germany
| | - Ravi De Silva
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Gil Bolotin
- Department of Cardiothoracic Surgery, Rambam Medical Center, Israel
| | - Stephan Jacobs
- Department of Cardiothoracic Surgery, German Heart Centre Berlin, Germany
| | - Matthias Thielmann
- Department of Cardiothoracic Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, Germany
| | - Yeong-Hoon Choi
- Kerkhoff-Klinik Bad Nauheim, Campus Kerkhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Sunil Ohri
- Department of Cardiothoracic Surgery, University Hospital Southampton, UK
| | - Alexander Lipey
- Department of Cardiothoracic Surgery, Sheba Medical Center, Israel
| | - Ivar Friedrich
- Herzzentrum Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany
| | - David P Taggart
- Department of Cardiac Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Vuong NL, Elfaituri MK, Eldoadoa M, Karimzadeh S, Mokhtar MA, Eid PS, Nam NH, Mostafa MR, Radwan I, Zaki MMM, Al Khudari R, Kassem M, Huy NT. Saphenous vein harvesting techniques for coronary artery bypass grafting: a systematic review and meta-analysis. Coron Artery Dis 2022; 33:128-136. [PMID: 34010184 DOI: 10.1097/mca.0000000000001048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The great saphenous vein (GSV) graft remains a frequently used conduit for coronary artery bypass graft (CABG) surgery. The optimal technique for GSV harvesting has been the subject of on-going controversy. We therefore sought to conduct a systematic review and meta-analysis of all available GSV harvesting techniques in CABG. A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any GSV harvesting technique, including conventional vein harvesting (CVH), no-touch, standard bridging technique (SBT) and endoscopic vein harvesting (EVH) techniques. We investigated safety and long-term efficacy outcomes. All outcomes were analyzed using the frequentist network meta-analysis. A total of 6480 patients from 34 RCTs were included. For safety outcomes, EVH reduced 91% and 77% risk of wound infection compared to no-touch and CVH, respectively. EVH and SBT also significantly reduced the risk of sensibility disorder and postoperative pain. The techniques were not significantly different regarding long-term efficacy outcomes, including mortality, myocardial infarction and graft patency. For GSV harvesting for CABG, EVH techniques are the most favorable, but in case of using an open technique, no-touch is more recommended than CVH. More effective and safer procedures should be investigated for GSV harvesting in CABG.
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Affiliation(s)
- Nguyen Lam Vuong
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Muhammed Khaled Elfaituri
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Medicine - University of Tripoli, Tripoli, Libya
| | - Mohammed Eldoadoa
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Milton Keynes University Hospital, Milton Keynes, UK
| | - Sedighe Karimzadeh
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohamed Ashraf Mokhtar
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, Sohag University, Sohag
| | - Peter Samuel Eid
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nguyen Hai Nam
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mostafa Reda Mostafa
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- School of Medicine, Tanta University, Tanta
| | - Ibrahim Radwan
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Mostafa Mohamed Zaki
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Clinical Pharmacy, Fayoum university, Fayoum, Egypt
| | - Rawan Al Khudari
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Pediatric Department, Children's University Hospital, Damascus University, Damascus, Syria
| | - Mahmoud Kassem
- Online Research Club ( http://www.onlineresearchclub.org ), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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9
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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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10
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Yokoyama Y, Shimamura J, Takagi H, Kuno T. Harvesting techniques of the saphenous vein graft for coronary artery bypass: Insights from a network meta-analysis. J Card Surg 2021; 36:4369-4375. [PMID: 34472140 DOI: 10.1111/jocs.15974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/19/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The optimal harvesting technique of saphenous vein (SVG) in coronary artery bypass grafting (CABG) is still to be elucidated. The present study aimed to compare the methods of SVG harvesting technique, which were open vein harvesting (OVH), endoscopic vein harvesting (EVH), and no-touch vein harvesting (NT), using a network meta-analysis of randomized controlled trials (RCTs), and propensity-score matched (PSM) studies. METHODS MEDLINE and EMBASE were searched through April 2021 to identify RCTs and PSM studies that investigated the outcomes in patients who underwent CABG with the SVG using one of three methods; OVH, EVH, and NT. The outcomes of interest were all-cause mortality, the rates of revascularization, and graft failure. Risk ratios (RRs) were extracted for the rates of graft failure, and hazard ratios (HRs) were extracted for all-cause mortality and the rates of revascularization. RESULTS Eligible seven RCT and five PSM studies were identified which enrolled a total of 8111 patients. All-cause mortality was significantly lower in patients with EVH compared with OVH (HR [95% confidence interval (CI)] =0.77 [0.65-0.92], p = .0032). The rates of revascularization were similar among the groups. The rate of graft failures was significantly lower in patients with NT compared with OVH (HR [95% CI] =0.54 [0.32-0.90], p = .019) and with EVH (HR [95% CI] =0.39 [0.17-0.86], p = .023). CONCLUSION NT vein harvesting is favorable for graft patency, and OVH showed higher all-cause mortality than EVH. Further well-powered RCTs are needed to confirm our findings.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Pennsylvania, USA
| | - Junichi Shimamura
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, Ontario, Canada
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, USA.,Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
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11
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Transit time flow measurement of coronary bypass grafts before and after protamine administration. J Cardiothorac Surg 2021; 16:195. [PMID: 34243799 PMCID: PMC8268198 DOI: 10.1186/s13019-021-01575-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background Intraoperative graft assessment with tools like Transit Time Flow Measurement (TTFM) is imperative for quality control in coronary surgery. We investigated the variation of TTFM parameters before and after protamine administration to identify new benchmark parameters for graft quality assessment. Methods The database of the REQUEST (“REgistry for QUality AssESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery”) study was retrospectively reviewed. A per graft analysis was performed. Only single grafts (i.e., no sequential nor composite grafts) where both pre- and post-protamine TTFM values were recorded with an acoustical coupling index > 30% were included. Grafts with incomplete data and mixed grafts (arterio-venous) were excluded. A second analysis was performed including single grafts only in the same MAP range pre- and post- protamine administration. Results After adjusting for MAP, we found a small increase in MGF (29 mL/min to 30 mL/min, p = 0.009) and decrease in PI (2.3 to 2.2, p < 0.001) were observed after the administration of protamine. These changes were especially notable for venous conduits and for CABG procedures performed on-pump. Conclusion The small changes in TTFM parameters observed before and after protamine administration seem to be clinically irrelevant, despite being statistically significant in aggregate. Our data do not support a need to perform TTFM measurements both before and after protamine administration. A single TTFM measurement taken either before or after protamine may suffice to achieve reliable data on each graft’s performance. Depending on the specific clinical situation and intraoperative changes, more measurements may be informative. Trial registration Clinical Trials Number: NCT02385344, registered February 17th, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01575-y.
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Akowuah E, Burns D, Zacharias J, Kirmani BH. Endoscopic vein harvesting. J Thorac Dis 2021; 13:1899-1908. [PMID: 33841978 PMCID: PMC8024854 DOI: 10.21037/jtd-20-1819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009-2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.
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Affiliation(s)
- Enoch Akowuah
- Department of Cardiac Surgery, James Cook University Hospital, South Tees NHS, Foundation Trust, Middlesbrough, UK
| | - Daniel Burns
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Bilal H Kirmani
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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13
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3979] [Impact Index Per Article: 994.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Antonopoulos AS, Odutayo A, Oikonomou EK, Trivella M, Petrou M, Collins GS, Antoniades C. Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis. J Thorac Cardiovasc Surg 2020; 160:116-127.e4. [PMID: 31606176 PMCID: PMC7322547 DOI: 10.1016/j.jtcvs.2019.07.086] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Early saphenous vein graft (SVG) occlusion is typically attributed to technical factors. We aimed at exploring clinical, anatomical, and operative factors associated with the risk of early SVG occlusion (within 12 months postsurgery). METHODS Published literature in MEDLINE was searched for studies reporting the incidence of early SVG occlusion. Individual patient data (IPD) on early SVG occlusion were used from the SAFINOUS-CABG Consortium. A derivation (n = 1492 patients) and validation (n = 372 patients) cohort were used for model training (with 10-fold cross-validation) and external validation respectively. RESULTS In aggregate data meta-analysis (48 studies, 41,530 SVGs) the pooled estimate for early SVG occlusion was 11%. The developed IPD model for early SVG occlusion, which included clinical, anatomical, and operative characteristics (age, sex, dyslipidemia, diabetes mellitus, smoking, serum creatinine, endoscopic vein harvesting, use of complex grafts, grafted target vessel, and number of SVGs), had good performance in the derivation (c-index = 0.744; 95% confidence interval [CI], 0.701-0.774) and validation cohort (c-index = 0.734; 95% CI, 0.659-0.809). Based on this model. we constructed a simplified 12-variable risk score system (SAFINOUS score) with good performance for early SVG occlusion (c-index = 0.700, 95% CI, 0.684-0.716). CONCLUSIONS From a large international IPD collaboration, we developed a novel risk score to assess the individualized risk for early SVG occlusion. The SAFINOUS risk score could be used to identify patients that are more likely to benefit from aggressive treatment strategies.
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Affiliation(s)
- Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ayodele Odutayo
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Marialena Trivella
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Mario Petrou
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
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Samano N, Souza D, Pinheiro BB, Kopjar T, Dashwood M. Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance. Braz J Cardiovasc Surg 2020; 35:91-99. [PMID: 32270965 PMCID: PMC7089755 DOI: 10.21470/1678-9741-2019-0238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.
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Affiliation(s)
- Ninos Samano
- Örebro University Faculty of Medicine and Health Örebro Sweden Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Domingos Souza
- Örebro University Faculty of Medicine and Health Department of Cardiothoracic and Vascular Surgery Örebro Sweden Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bruno Botelho Pinheiro
- Hospital do Coração Anis Rassi Department Cardiovascular Surgery Goiânia GO Brazil Department Cardiovascular Surgery, Hospital do Coração Anis Rassi, Goiânia, GO, Brazil
| | - Tomislav Kopjar
- University Hospital Centre Zagreb University of Zagreb School of Medicine Department of Cardiac Surgery Zagreb Croatia Department of Cardiac Surgery, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia
| | - Michael Dashwood
- University College London Medical School Royal Free Hospital Campus Surgical and Interventional Sciences London UK Surgical and Interventional Sciences, Royal Free Hospital Campus, University College London Medical School, London, UK
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16
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Mid-term and long-term outcomes of endoscopic versus open vein harvesting for coronary artery bypass: A systematic review and meta-analysis. Int J Surg 2019; 72:167-173. [DOI: 10.1016/j.ijsu.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 01/12/2023]
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17
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Kroeze VJ, Lam KY, van Straten AH, Houterman S, Soliman-Hamad MA. Benefits of Endoscopic Vein Harvesting in Coronary Artery Bypass Grafting. Ann Thorac Surg 2019; 108:1793-1799. [DOI: 10.1016/j.athoracsur.2019.04.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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18
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Leyvi G, Dabas A, Leff JD. Hybrid Coronary Revascularization - Current State of the Art. J Cardiothorac Vasc Anesth 2019; 33:3437-3445. [DOI: 10.1053/j.jvca.2019.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/11/2022]
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19
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El-Kurdi M, Soletti L, McGrath J, Linhares S, Rousselle S, Greisler H, Edelman E, Schoen FJ. Functional remodeling of an electrospun polydimethylsiloxane-based polyether urethane external vein graft support device in an ovine model. J Biomed Mater Res A 2019; 107:2135-2149. [PMID: 31094084 PMCID: PMC6689261 DOI: 10.1002/jbm.a.36724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 11/07/2022]
Abstract
Saphenous vein graft (SVG) failure rates are unacceptably high, and external mechanical support may improve patency. We studied the histologic remodeling of a conformal, electrospun, polydimethylsiloxane-based polyether urethane external support device for SVGs and evaluated graft structural evolution in adult sheep to 2 years. All sheep (N = 19) survived to their intended timepoints, and angiography showed device-treated SVG geometric stability over time (30, 90, 180, 365, or 730 days), with an aggregated graft patency rate of 92%. There was minimal inflammation associated with the device material at all timepoints. By 180 days, treated SVG remodeling was characterized by minimal/nonprogressive intimal hyperplasia; polymer fragmentation and integration; as well as the development of a neointima, and a confluent endothelium. By 1-year, the graft developed a media-like layer by remodeling the neointima, and elastic fibers formed well-defined structures that subtended the neo-medial layer of the remodeled SVG. Immunohistochemistry showed that this neo-media was populated with smooth muscle cells, and the intima was lined with endothelial cells. These data suggest that treated SVGs were structurally remodeled by 180 days, and developed arterial-like features by 1 year, which continued to mature to 2 years. Device-treated SVGs remodeled into arterial-like conduits with stable long-term performance as arterial grafts in adult sheep.
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Affiliation(s)
| | | | | | | | | | - Howard Greisler
- Loyola University, Maywood, IL and Hines VA Hospital, Hines, IL
| | - Elazer Edelman
- Massachusetts Institute of Technology, Cambridge, MA, Harvard Medical School, Boston, MA, Brigham and Women’s Hospital, Boston, MA
| | - Frederick J. Schoen
- Brigham and Women’s Hospital, Boston, MA, and Harvard Medical School, Boston, MA
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20
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Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2019; 17:155-169. [DOI: 10.1038/s41569-019-0249-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
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21
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Soni MK, Williams L, Raja SG. Use of endoscopic vein harvesting (EVH) during coronary artery bypass grafting in United Kingdom: The EVH survey. Int J Surg 2019; 69:146-151. [PMID: 31398455 DOI: 10.1016/j.ijsu.2019.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/07/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Endoscopic vein harvesting (EVH) is growing in popularity and is the method of choice in many centers worldwide as it is associated with lower complication rates compared to the open vein harvesting. The aim of this study was to determine the current use of EVH during coronary artery bypass grafting among cardiac surgeons in United Kingdom and identify the main concerns that limit the use of this technique. METHODS We developed an online survey with 16 questions about the use of EVH. An invitation to participate was sent to all the adult cardiac surgeons currently in practice in United Kingdom. RESULTS A total of 139 surgeons (52%) of 267 currently in practice across 48 different hospitals completed the survey. Twenty five percent of responding surgeons always use EVH while 44% use it for <10% cases. Forty eight percent of responders regard EVH as an expensive technique and 90% believe that EVH is associated with fewer leg wound issues. Seventy five percent of responding surgeons will use it for their patients due to no leg wound issues while 25% believe that the concerns about patency of EVH are genuine. CONCLUSION The majority of UK cardiac surgeons responding to this survey will preferentially consider EVH for obese and diabetic patients and are convinced by its beneficial impact in reducing leg wound complications. However, the reported routine use of EVH is low. Concerns about cost and patency of the endoscopically harvested vein are the possible barriers for universal adoption of EVH in the United Kingdom.
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Affiliation(s)
- Manish K Soni
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Luke Williams
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
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22
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Harky A, MacCarthy‐Ofosu B, Grafton‐Clarke C, Pousios D, Muir AD. Long saphenous vein harvesting techniques and their effect on graft patency. J Card Surg 2019; 34:821-828. [DOI: 10.1111/jocs.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | | | | | - Dimitrios Pousios
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | - Andrew D. Muir
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
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“No-Touch” versus “Endo” Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 9:306-11. [DOI: 10.1097/imi.0000000000000084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective “No-touch” (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate. Methods During a 2-year period (2011–2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients). Results The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins ( P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients ( P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates ( P = 0.27). Conclusions These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.
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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 2019; 1:61-74. [DOI: 10.1097/01.gim.0000196316.48694.41] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective This meta-analysis sought to determine whether endoscopic vascular graft harvesting (EVH) improves clinical and resource outcomes compared with conventional open graft harvesting (OVH) in adults undergoing coronary artery bypass surgery. Methods A comprehensive search was undertaken to identify all randomized and nonrandomized trials of EVH versus OVH up to April 2005. The primary outcome was wound complications. Secondary outcomes included any other clinical morbidity and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD) and their 95% confidence intervals (95% CI) were analyzed. Results Thirty-six trials of 9,632 patients undergoing saphenous vein harvest met the inclusion criteria (13 randomized; 23 nonrandomized). Risk of wound complications was significantly reduced by EVH compared with OVH (OR 0.31, 95% CI 0.23–0.41). Similarly, the risk of wound infections was significantly reduced (OR 0.23, 95% CI 0.20–0.53; P < 0.0001). Need for surgical wound intervention was also significantly reduced (OR 0.16, 95% CI 0.08–0.29). The incidence of pain, neuralgia, and patient satisfaction was improved with EVH compared with OVH. Postoperative myocardial infarction, stroke, reintervention for ischemia or angina recurrence, and mortality were not significantly different. Operative time was significantly increased (WMD 15.26 minutes; 95% CI 0.01, 30.51), hospital length of stay was reduced (WMD −0.85 days; 95% CI −1.55, −0.15), and readmissions were reduced (OR 0.53, 95% CI 0.29–0.98). Costs were insufficiently reported to allow for aggregate analysis. Conclusions Endoscopic vascular graft harvesting of the saphenous vein reduces wound complications and improves patient satisfaction and resource utilization. Further research is required to determine the incremental cost-effectiveness of EVH versus OVH.
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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26
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Cheng D, Allen K, Cohn W, Connolly M, Edgerton J, Falk V, Martin J, Ohtsuka T, Vitali R. 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 2019. [DOI: 10.1177/155698450500100202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Davy Cheng
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Keith Allen
- The Heart Center of Indiana, Division of Cardiothoracic Surgery, Indianapolis, IN
| | | | | | - James Edgerton
- Cardiopulmonary Research Science and Technology Institute, Dallas, TX
| | - Volkmar Falk
- Klinik fur Herzchirurgie, Herzzentrum Leipzig, Germany
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Toshiya Ohtsuka
- Department of Cardiothoracic Surgery, Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan
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Nicolini F. Editorial on the article entitled "Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study". J Thorac Dis 2019; 10:S3938-S3941. [PMID: 30631521 DOI: 10.21037/jtd.2018.09.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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Minimally invasive coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2018; 34:302-309. [PMID: 33060953 DOI: 10.1007/s12055-017-0631-x] [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: 10/23/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
Minimally invasive cardiac surgery (MICS)-CABG is a technique that at its core has patient comfort, early return to routine activities, meeting patient expectations for less invasive options, and maintaining the highest possible standards of care and outcomes. The technique requires not only surgical dexterity but also integration of significant technological advancements in patient care. At a time when percutaneous interventions are often prescribed on the pretext of increased patient comfort and demand, minimally invasive myocardial revascularization becomes even more relevant. Minimally invasive myocardial revascularization is ever evolving and encompasses both small-incision open techniques as well as endoscopic-assisted procedures. The success of the procedure depends not only on the learning curve and familiarity with the technology but also on appropriate patient selection. Mere feasibility of the technique is not sufficient, and the results have to be comparable with the long-established techniques of conventional coronary artery bypass grafting both in terms of early morbidity and mortality as well as long-term outcomes. In this review, we discuss patient selection and technical aspects of minimally invasive coronary artery bypass grafting. We also provide an evidence-based comparison to early and long-term outcomes with conventional coronary artery bypass grafting. Finally, we review the uptake and outcomes of minimally invasive revascularization in the Indian subcontinent.
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Kayatta MO, Halkos ME. A review of hybrid coronary revascularization. Indian J Thorac Cardiovasc Surg 2018; 34:321-329. [PMID: 33060955 DOI: 10.1007/s12055-018-0763-7] [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: 02/06/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose Hybrid coronary revascularization is an emerging treatment strategy for coronary artery disease. We will review the reasons for the development of this strategy, describe surgical techniques, and review outcomes. Finally, we will discuss the future of hybrid revascularization and explain why it will grow as a treatment modality. Methods For this review, we conducted an unstructured review of the literature for articles related to hybrid coronary revascularization, bypass surgery, and percutaneous coronary interventions. Results Hybrid coronary revascularization has been shown in large series to have excellent results. These include fast recovery time, low mortality and rates of complications, and excellent surgical graft patency. There may be increased need for revascularization over conventional bypass surgery. Conclusions The combination improved surgical techniques including a robotic surgery platform, as well as the ever-improving efficacy and durability of coronary stents have made hybrid coronary revascularization an attractive option for many patients. It offers a minimally invasive approach to surgery while avoiding the poor patency of saphenous vein grafts. In appropriately selected patients, this may be an ideal treatment strategy that minimizes risks and maximizes short- and long-term benefits.
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Affiliation(s)
- Michael Owen Kayatta
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
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Kodia K, Patel S, Weber MP, Luc JGY, Choi JH, Maynes EJ, Rizvi SSA, Horan DP, Massey HT, Entwistle JW, Morris RJ, Tchantchaleishvili V. Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis. Ann Cardiothorac Surg 2018; 7:586-597. [PMID: 30505742 DOI: 10.21037/acs.2018.07.05] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Saphenous vein grafts (SVG) are a commonly used conduit for coronary artery bypass graft (CABG) surgery and can be harvested by either an open or endoscopic technique. Our goal was to evaluate long-term angiographic and clinical outcomes of open compared to endoscopic SVG harvest for CABG. Methods Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality. Results Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30-day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34]. Conclusions Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.
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Affiliation(s)
- Karishma Kodia
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sinal Patel
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jae Hwan Choi
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Dylan P Horan
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Loesch A, Dashwood MR. Vasa vasorum inside out/outside in communication: a potential role in the patency of saphenous vein coronary artery bypass grafts. J Cell Commun Signal 2018; 12:631-643. [PMID: 30078142 PMCID: PMC6235771 DOI: 10.1007/s12079-018-0483-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/30/2018] [Indexed: 01/08/2023] Open
Abstract
The saphenous vein (SV) is the most commonly used conduit for revascularization in patients undergoing coronary artery bypass surgery (CABG). The patency rate of this vessel is inferior to the internal thoracic artery (ITA). In the majority of CABG procedures the ITA is removed with its outer pedicle intact whereas the (human) SV (hSV) is harvested with pedicle removed. The vasa vasorum, a microvessel network providing the adventitia and media with oxygen and nutrients, is more pronounced and penetrates deeper towards the lumen in veins than in arteries. When prepared in conventional CABG the vascular trauma caused when removing the hSV pedicle damages the vasa vasorum, a situation affecting transmural flow potentially impacting on graft performance. In patients, where the hSV is harvested with pedicle intact, the vasa vasorum is preserved and transmural blood flow restored at graft insertion and completion of CABG. By maintaining blood supply to the hSV wall, apart from oxygen and nutrients, the vasa vasorum may also transport factors potentially beneficial to graft performance. Studies, using either corrosion casts or India ink, have shown the course of vasa vasorum in animal SV as well as in hSV. In addition, there is some evidence that vasa vasorum of hSV terminate in the vessel lumen based on ex vivo perfusion, histological and ultrastructural studies. This review describes the preparation of the hSV as a bypass conduit in CABG and its performance compared with the ITA as well as how and why its patency might be improved by harvesting with minimal trauma in a way that preserves an intact vasa vasorum.
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Affiliation(s)
- Andrzej Loesch
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Michael R Dashwood
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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Pinho-Gomes AC, Azevedo L, Antoniades C, Taggart DP. Comparison of graft patency following coronary artery bypass grafting in the left versus the right coronary artery systems: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2018; 54:221-228. [PMID: 29506201 DOI: 10.1093/ejcts/ezy060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/28/2018] [Indexed: 11/08/2023] Open
Abstract
Although coronary artery bypass grafting has been the standard of care for patients with complex coronary artery disease for over 50 years, the evolution of graft patency over time in the left versus the right coronary systems remains poorly documented. This systematic review and meta-analysis aimed to characterize the evolution of graft patency over time comparing the left (excluding left anterior descending artery) and right coronary systems, with an emphasis on the comparison of venous versus arterial grafts and symptomatic versus asymptomatic patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE from inception to August 2016. We also searched clinical trials registers and reference lists of relevant studies. We included randomized clinical trials and observational studies comparing graft patency in the left versus the right coronary systems. Our outcome was graft patency defined as a binary variable according to whether grafts were reported as patent or failed at the time of angiogram. Data collection and analysis were performed according to the methodological recommendations of the Cochrane Collaboration. From a total 2275 papers, 52 studies were included in the qualitative analysis and 48 studies (including 36 006 grafts) in the meta-analysis. There was a 3.3% significant difference between the left-sided and right-sided graft patency, and the difference appeared to increase over time. Furthermore, patency of arterial grafts was higher in the left coronary system, while venous grafts performed similarly irrespective of the coronary circulation. Symptom recurrence also seemed related to a higher failure rate in the right coronary circulation. However, the high degree of heterogeneity precluded drawing definite conclusions. This meta-analysis suggested that graft patency might be better for left-sided vessels and that this difference might be driven by the better performance of arterial grafts in the left coronary system. However, evidence currently available is limited, and further research is warranted to understand whether certain grafts achieve better patency in the right versus the left coronary circulations.
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Affiliation(s)
| | - Luis Azevedo
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | | | - David P Taggart
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Mirza AK, Stauffer K, Fleming MD, De Martino R, Oderich G, Kalra M, Gloviczki P, Bower T. Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass. J Vasc Surg 2018; 67:1199-1206. [DOI: 10.1016/j.jvs.2017.08.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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Gulack BC, Kirkwood KA, Shi W, Smith PK, Alexander JH, Burks SG, Gelijns AC, Thourani VH, Bell D, Greenberg A, Goldfarb SD, Mayer ML, Bowdish ME. Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study. J Thorac Cardiovasc Surg 2018; 155:1555-1562.e1. [PMID: 29221750 PMCID: PMC5860945 DOI: 10.1016/j.jtcvs.2017.10.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 10/06/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patient risk factors and processes of care associated with secondary surgical-site infection (SSI) after coronary artery bypass grafting (CABG). METHODS Data were collected prospectively between February and October 2010 for consenting adult patients undergoing CABG with saphenous vein graft (SVG) conduits. Patients who developed a deep or superficial SSI of the leg or groin within 65 days of CABG were compared with those who did not develop a secondary SSI. RESULTS Among 2174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range 11-29) with the majority (86%) diagnosed after discharge. Gram-positive bacteria were most common. Readmission was more common in patients with a secondary SSI (34% vs 17%, P < .01). After adjustment, an open SVG harvest approach was associated with an increased risk of secondary SSI (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.28-3.48). Increased body mass index (adjusted HR, 1.08, 95% CI, 1.04-1.12) and packed red blood cell transfusions (adjusted HR, 1.13; 95% CI, 1.05-1.22) were associated with a greater risk of secondary SSI. Antibiotic type, antibiotic duration, and postoperative hyperglycemia were not associated with risk of secondary SSI. CONCLUSIONS Secondary SSI after CABG continues to be an important source of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger body mass, and blood transfusions. Patients with a secondary SSI have longer lengths of stay and are readmitted more frequently.
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Affiliation(s)
- Brian C Gulack
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Health, Durham, NC
| | - Katherine A Kirkwood
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Health, Durham, NC
| | - John H Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke Health, Durham, NC
| | - Sandra G Burks
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY.
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Daniel Bell
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Ann Greenberg
- Department of Cardiothoracic Surgery, NIH Heart Center at Suburban Hospital, Bethesda, Md
| | - Seth D Goldfarb
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY
| | - Mary Lou Mayer
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Michael E Bowdish
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
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Matsuyama S, Imazuru T, Nakagawa K, Chen K, Saga T, Ikeda T, Ota H, Ozawa N, Nishimura K, Iida M, Shimokawa T. The early and mid-term outcomes of endoscopic saphenous vein harvesting in coronary artery bypass grafting. ACTA ACUST UNITED AC 2018. [DOI: 10.7793/jcoron.24.18-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Tomohiro Imazuru
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Kaori Nakagawa
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Ken Chen
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Toshifumi Saga
- Department of Cardiovascular Surgery, New Tokyo Hospital
| | - Tsukasa Ikeda
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Hiroo Ota
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Naomi Ozawa
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Kenji Nishimura
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, Teikyo University Hospital
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University Hospital
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Lazar HL. CO 2 insufflation during endoscopic vein harvesting-Surgeon beware! J Card Surg 2017; 32:790. [PMID: 29169216 DOI: 10.1111/jocs.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Massachusetts
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Suarez-Pierre A, Terasaki Y, Magruder JT, Kapoor A, Grant MC, Lawton JS. Complications of CO 2 insufflation during endoscopic vein harvesting. J Card Surg 2017; 32:783-789. [PMID: 29169212 DOI: 10.1111/jocs.13249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Over the past few decades, the use of endoscopic harvest of the saphenous vein has gained popularity due to a significant reduction in rates of wound infection and improved cosmesis. The widespread adoption of this technique has introduced a set of complications associated with the use CO2 insufflation which facilitates exposure during the vein harvest. We describe a case of pneumoperitoneum with systemic acidosis and subcutaneous air following endoscopic vein harvest for coronary artery bypass grafting and review the complications that may arise from CO2 insufflation during endoscopic vein harvesting.
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Affiliation(s)
- Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yusuke Terasaki
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Trent Magruder
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anubhav Kapoor
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ferdinand FD, MacDonald JK, Balkhy HH, Bisleri G, Young Hwang H, Northrup P, Trimlett RHJ, Wei L, Kiaii BB. Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - John K. MacDonald
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Husam H. Balkhy
- Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada
| | - Ho Young Hwang
- Division of Cardiac Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Patricia Northrup
- Division of Cardiothoracic Surgery, Albany Medical College, Albany, NY USA
| | - Richard H. J. Trimlett
- Department of Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Lai Wei
- Division of Cardiovascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Bob B. Kiaii
- Division of Cardiac Surgery, University Campus, Western University, London, Ontario, Canada
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Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:301-319. [DOI: 10.1097/imi.0000000000000410] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials. Methods All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,1,2 in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis. Based on the resultant, 76 studies (23 randomized controlled trials and 53 nonrandomized controlled trials) on 281,459 patients analyzed, consensus statements, and recommendations were generated comparing the risks and benefits of endoscopic versus open conduit harvesting for patients undergoing coronary artery bypass grafting. Results Compared with open vein harvest, it is reasonable to perform endoscopic vein harvest of saphenous vein to reduce wound-related complications, postoperative length of stay, and outpatient wound management resources and to increase patient satisfaction (class I, level A). Based on the quality of the conduit and major adverse cardiac events as well as 6-month angiographic patency, endoscopic vein harvest was noninferior to open harvest. It is reasonable to perform endoscopic radial artery harvest to reduce wound-related complication and to increase patient satisfaction (class I, level B-R and B-NR, respectively) with reduction in major adverse cardiac events and noninferior patency rate at 1 and 3 to 5 years (class III, level B-R). Conclusions Based on the consensus statements, the consensus panel recommends (class I, level B) that endoscopic saphenous vein and radial artery harvesting should be the standard of care for patients who require these conduits for coronary revascularization.
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Krishnamoorthy B, Critchley WR, Thompson AJ, Payne K, Morris J, Venkateswaran RV, Caress AL, Fildes JE, Yonan N. Study Comparing Vein Integrity and Clinical Outcomes in Open Vein Harvesting and 2 Types of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting: The VICO Randomized Clinical Trial (Vein Integrity and Clinical Outcomes). Circulation 2017. [PMID: 28637880 DOI: 10.1161/circulationaha.117.028261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current consensus statements maintain that endoscopic vein harvesting (EVH) should be standard care in coronary artery bypass graft surgery, but vein quality and clinical outcomes have been questioned. The VICO trial (Vein Integrity and Clinical Outcomes) was designed to assess the impact of different vein harvesting methods on vessel damage and whether this contributes to clinical outcomes after coronary artery bypass grafting. METHODS In this single-center, randomized clinical trial, patients undergoing coronary artery bypass grafting with an internal mammary artery and with 1 to 4 vein grafts were recruited. All veins were harvested by a single experienced practitioner. We randomly allocated 300 patients into closed tunnel CO2 EVH (n=100), open tunnel CO2 EVH (n=100), and traditional open vein harvesting (n=100) groups. The primary end point was endothelial integrity and muscular damage of the harvested vein. Secondary end points included clinical outcomes (major adverse cardiac events), use of healthcare resources, and impact on health status (quality-adjusted life-years). RESULTS The open vein harvesting group demonstrated marginally better endothelial integrity in random samples (85% versus 88% versus 93% for closed tunnel EVH, open tunnel EVH, and open vein harvesting; P<0.001). Closed tunnel EVH displayed the lowest longitudinal hypertrophy (1% versus 13.5% versus 3%; P=0.001). However, no differences in endothelial stretching were observed between groups (37% versus 37% versus 31%; P=0.62). Secondary clinical outcomes demonstrated no significant differences in composite major adverse cardiac event scores at each time point up to 48 months. The quality-adjusted life-year gain per patient was 0.11 (P<0.001) for closed tunnel EVH and 0.07 (P=0.003) for open tunnel EVH compared with open vein harvesting. The likelihood of being cost-effective, at a predefined threshold of £20 000 per quality-adjusted life-year gained, was 75% for closed tunnel EVH, 19% for open tunnel EVH, and 6% for open vein harvesting. CONCLUSIONS Our study demonstrates that harvesting techniques affect the integrity of different vein layers, albeit only slightly. Secondary outcomes suggest that histological findings do not directly contribute to major adverse cardiac event outcomes. Gains in health status were observed, and cost-effectiveness was better with closed tunnel EVH. High-level experience with endoscopic harvesting performed by a dedicated specialist practitioner gives optimal results comparable to those of open vein harvesting. CLINICAL TRIAL REGISTRATION URL: https://www.isrctn.com. International Standard Randomised Controlled Trial Registry Number: 91485426.
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Affiliation(s)
- Bhuvaneswari Krishnamoorthy
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.).
| | - William R Critchley
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Alexander J Thompson
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Katherine Payne
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Julie Morris
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Rajamiyer V Venkateswaran
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Ann L Caress
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - James E Fildes
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
| | - Nizar Yonan
- From Departments of Cardiothoracic Surgery (B.K., R.V.V., N.Y.) and Medical Statistics (J.M.), University Hospital of South Manchester NHS Foundation Trust, United Kingdom; Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (W.R.C., B.K.), Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health (J.E.F.), Manchester Centre for Health Economics (A.J.T., K.P.), and School of Nursing and Midwifery (A.L.C.), University of Manchester, United Kingdom; and Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom(B.K.)
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Harky A, Balmforth D, Shipolini A, Uppal R. Is endoscopic long saphenous vein harvesting equivalent to open harvesting technique in terms of graft patency? Interact Cardiovasc Thorac Surg 2017; 25:323-326. [DOI: 10.1093/icvts/ivx049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/30/2017] [Indexed: 11/12/2022] Open
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Taggart DP, Amin S, Djordjevic J, Oikonomou EK, Thomas S, Kampoli AM, Sabharwal N, Antoniades C, Krasopoulos G. A prospective study of external stenting of saphenous vein grafts to the right coronary artery: the VEST II study. Eur J Cardiothorac Surg 2017; 51:952-958. [DOI: 10.1093/ejcts/ezw438] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/17/2016] [Indexed: 11/15/2022] Open
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Repossini A. Hybrid approach to multivessel coronary artery disease: a commentary. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:S52. [PMID: 27868020 DOI: 10.21037/atm.2016.10.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Repossini
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy
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A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme. J Cardiothorac Surg 2016; 11:45. [PMID: 27059309 PMCID: PMC4825086 DOI: 10.1186/s13019-016-0442-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Endoscopic vein harvesting is becoming one of the most favourable vein harvesting techniques in multiple bypass coronary surgery, due to its short term post-operative benefits with high patient satisfaction. However, long-term graft patency has been both supported and questioned in the literature. Graft failure can be affected by harvesting methods and operator's experience. Endoscopic vein harvesting is associated with a learning curve period, during which the incidence of vein trauma is high due to unfamiliarity with the surgical technique. There is a paucity of structured learning tools for novice practitioners, meaning that training differs significantly between hospital centres. Inconsistent training methods can lead to poor surgical technique, which can have a significant impact on vein quality and stress level of the practitioner. In turn, this can lead to increased postoperative complications and longer surgical duration. The main aim of this literature review is to understand the impact of the learning curve on the vein conduit and whether there is a requirement for a standardised training programme for the novice practitioners.
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Kayatta MO, Halkos ME. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities. Expert Rev Cardiovasc Ther 2016; 14:821-30. [PMID: 27042753 DOI: 10.1080/14779072.2016.1174576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice.
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Affiliation(s)
- Michael O Kayatta
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
| | - Michael E Halkos
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
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Peinado Cebrián J, Flores Herrero Á, Salgado Lopetegui CL, Lamarca Mendoza MP, Montoya Ching R, Seco SE, Leal Lorenzo JI, Gil Sales J, Pérez-Grueso AO. Comparison of Bypass with Endoscopically Harvested Internal Saphenous Vein versus Bypass with Surgically Harvested Internal Saphenous Vein for Lower Limb Arterial Disease. Ann Vasc Surg 2015; 29:1353-62. [DOI: 10.1016/j.avsg.2015.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Kim DY, Song H, Kim HW, Jo GH, Kang J. Early Outcomes of Endoscopic Vein Harvesting during the Initial Learning Period. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:174-9. [PMID: 26078923 PMCID: PMC4463233 DOI: 10.5090/kjtcs.2015.48.3.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/14/2014] [Accepted: 10/27/2014] [Indexed: 12/05/2022]
Abstract
Background The endoscopic vein harvesting (EVH) method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. Methods Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group) who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. Results Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791). Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127). According to the analysis, age was an independent risk factor for leg wound complications. Conclusion EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.
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Affiliation(s)
- Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine
| | - Hyun Song
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine
| | - Gyun Hyun Jo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine
| | - Joonkyu Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine
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