Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio

Abstract

Objective: To comparatively analyze minimally invasive procurement of saphenous veins using the MINI-HARVEST ® system and a technique using adapted traditional instruments.Method: From June 1996 to January 1999, 63 patients who were submitted to coronary artery bypass grafting surgery had their saphenous veins resected using minimally invasive techniques. For the first 30 patients of the series, a direct visualization method employing two Langenbeck's retractors was utilized and for the remaining 33 patients the MINI-HARVEST ® technique was used.Results: The mean age of the patients was 61 ± 8.75 years old. Fifty-two patients were male and 11 female. Forty-five patients were diabetics, 45 were either overweight or obese, 25 were smokers and 32 presented histories of myocardial infarction. The mean time to resect the saphenous vein using the Langenbeck's retractors was 34.2 ± 8.14 minutes and using the MINI-HARVEST ® system it was 39.20 ± 9.12 minutes. The lengths of the extracted veins were similar in both groups, varying between 10 and 30 cm. There was one case of superficial dehiscence in the Langenbeck group. With two patients in the MINI-HARVEST ® group and one in the Langenbeck group it was necessary to revert to the traditional method of procurement. The incidence of trans-operative infarction was 4.5 % (three patients) in the Langenbeck group and 3.1% (two patients) in the MINI-HARVEST ® group.Conclusions: We can conclude that the minimally invasive procurement methods of the saphenous vein by direct visualization are effective and safe, both when employing with adapted traditional instruments and when using purposemade retractors. We stress, however, that the MINI-HARVEST ® method does not require an assistant.