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Kaveshnikov VS, Kuzmichkina MA, Serebryakova VN. Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2022-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control.
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Affiliation(s)
- V. S. Kaveshnikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - M. A. Kuzmichkina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - V. N. Serebryakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
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Jarrett CM, Pelletier M, Abu-Omar Y, Baeza C, Elgudin Y, Markowitz A, Vega PR, Dressler O, Kappetein AP, Serruys PW, Stone GW, Sabik JF. Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery for Left Main Disease Trial. Ann Thorac Surg 2023; 115:72-78. [PMID: 35283098 DOI: 10.1016/j.athoracsur.2021.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND We investigated outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH) within the Evaluation of XIENCE Versus CABG (EXCEL) trial. METHODS All patients in EXCEL randomized to CABG were included in this study. For this analysis, the primary end points were ischemia-driven revascularization (IDR) and graft stenosis or occlusion at 5 years. Additional end points were as follows: a composite of death from any cause, stroke, or myocardial infarction; bleeding; blood product transfusion; major arrhythmia; and infection requiring antibiotics. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS Of the 957 patients randomized to CABG, 686 (71.7%) received at least 1 venous graft with 257 (37.5%) patients in the EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3% vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%; P = .94), and infection requiring antibiotics within 1 month (13.6% vs 16.8%; P = .27) were similar between EVH and OVH patients. Major arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month (21.8% vs 15.4%; P = .03) was higher in EVH patients. CONCLUSIONS IDR at 5 years was higher in the EVH group. EVH and OVH patients had similar rates of graft stenosis or occlusion and the composite of death, stroke, or myocardial infarction at 5 years.
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Affiliation(s)
- Craig M Jarrett
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marc Pelletier
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yasir Abu-Omar
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cristian Baeza
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan Markowitz
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Pablo Ruda Vega
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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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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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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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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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: 4013] [Impact Index Per Article: 1003.3] [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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Kirmani BH, Power S, Zacharias J. Long-term survival after endoscopic vein harvest for coronary artery bypass grafting. Ann R Coll Surg Engl 2020; 102:422-428. [PMID: 32326723 DOI: 10.1308/rcsann.2020.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Endoscopic vein harvest is the technique of choice in North America, where it constitutes 80% of conduit harvest for coronary artery bypass grafting. The UK has much lower rates, despite demonstrable perioperative benefits. Concerns about patency and long-term survival are often cited as reasons for poor uptake and evidence in the literature thus far has only addressed mid-term outcomes. We sought to identify the long-term survival of patients undergoing endoscopic vein harvest compared with a contemporaneous cohort of open vein harvest. MATERIALS AND METHODS This was a retrospective cohort study of all consecutive patients undergoing isolated coronary artery bypass grafting at a single institution between 2007 and 2017. All-cause long-term mortality was compared using Kaplan-Meier curves and log-rank analysis. RESULTS A total of 7,527 patients undergoing coronary artery bypass grafting (1,029 receiving endoscopic vein harvest) were studied. The groups were well matched for preoperative characteristics, except that there were more patients with triple-vessel disease and good left-ventricular function in the endoscopic vein harvest group. There was no statistically significant difference in the long-term survival (p = 0.23). At five years (median follow-up), survival was 86.1% (95% confidence interval 85.3-87.0) in the open vein harvest group compared with 85.5% (95% confidence interval 82.8-88.2) in the endoscopic vein harvest group. DISCUSSION AND CONCLUSION Endoscopic vein harvest does not affect long-term survival in an unselected population. The contraindications for minimally invasive vein harvest in coronary artery bypass grafting are increasingly diminishing.
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Affiliation(s)
- B H Kirmani
- Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - S Power
- Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Zacharias
- Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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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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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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10
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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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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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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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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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Luo W, Guth CM, Jolayemi O, Duvall CL, Brophy CM, Cheung-Flynn J. Subfailure Overstretch Injury Leads to Reversible Functional Impairment and Purinergic P2X7 Receptor Activation in Intact Vascular Tissue. Front Bioeng Biotechnol 2016; 4:75. [PMID: 27747211 PMCID: PMC5040722 DOI: 10.3389/fbioe.2016.00075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022] Open
Abstract
Vascular stretch injury is associated with blunt trauma, vascular surgical procedures, and harvest of human saphenous vein for use in vascular bypass grafting. A model of subfailure overstretch in rat abdominal aorta was developed to characterize surgical vascular stretch injury. Longitudinal stretch of rat aorta was characterized ex vivo. Stretch to the haptic endpoint, where the tissues would no longer lengthen, occurred at twice the resting length. The stress produced at this length was greater than physiologic mechanical forces but well below the level of mechanical disruption. Functional responses were determined in a muscle bath, and this subfailure overstretch injury led to impaired smooth muscle function that was partially reversed by treatment with purinergic receptor (P2X7R) antagonists. These data suggest that vasomotor dysfunction caused by subfailure overstretch injury may be due to the activation of P2X7R. These studies have implications for our understanding of mechanical stretch injury of blood vessels and offer novel therapeutic opportunities.
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Affiliation(s)
- Weifeng Luo
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Christy M. Guth
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Olukemi Jolayemi
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Craig L. Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Colleen Marie Brophy
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
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Amouzeshi A, Teshnisi MA, Zirak N, Shamloo AS, Hoseinikhah H, Alizadeh B, Moeinipour A. Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad. Electron Physician 2016; 8:1693-700. [PMID: 26955438 PMCID: PMC4768916 DOI: 10.19082/1693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes. METHODS This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis. RESULTS The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques. CONCLUSION EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH.
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Affiliation(s)
- Ahmad Amouzeshi
- M.D., Assistant Professor, Department of Cardiac Surgery, Faculty of Medicine, Birjand University of Medical Science, Birjand, Iran
| | - Mohamad Abbassi Teshnisi
- M.D., Associate Professor, Department of Cardiac Surgery, Faculty of Medicine, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
| | - Nahid Zirak
- M.D., Associate Professor, Department of Anesthesiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
| | - Alireza Sepehri Shamloo
- Medical Student, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Hoseinikhah
- M.D., Assistant Professor, Department of Cardiac Surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
| | - Behzad Alizadeh
- M.D., Assistant Professor, Department of Pediatric Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
| | - Aliasghar Moeinipour
- M.D., Assistant Professor, Department of Cardiac Surgery, Faculty of Medicine, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
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IS local wound infection rate more important than long-term graft patency in coronary artery bypass grafting? J Thorac Cardiovasc Surg 2015; 151:275. [PMID: 26699777 DOI: 10.1016/j.jtcvs.2015.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/24/2022]
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