Association Between Endoscopic vs Open Vein-Graft Harvesting and Mortality, Wound Complications, and Cardiovascular Events in Patients Undergoing CABG Surgery

Williams, Judson B.; Peterson, Eric D.; Brennan, James M.; Sedrakyan, Art; Tavris, Dale R.; Alexander, John H.; Lópes, Renato D.; Dokholyan, Rachel S.; Zhao, Yue; O’Brien, Sean M.; Michler, Robert E.; Thourani, Vinod H.; Edwards, Fred H.; Duggirala, Hesha J.; Gross, Thomas P.; Marinac‐Dabic, Danica; Smith, Peter K.

doi:10.1001/jama.2012.8363

Cited by 88 publications

(62 citation statements)

References 36 publications

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“…[9]. В настоящее время благоприятное воздей-ствие метода на раневое заживление хорошо изучено и не вызывает сомнений [5,13,14]. Продолжаются споры о влиянии ЭВВ на про-ходимость аортокоронарных шунтов [7,12].…”

Section: теоретическая и клиническая медицинаunclassified

“…Внедрение эндоскопического метода выделения большой подкожной вены (эндо-скопическое выделение вены -ЭВВ) в ко-ронарную хирургию сыграло важную роль в профилактике послеоперационных ране-вых осложнений и уменьшении интенсив-ности послеоперационных болей на ноге [5,13,14]. В настоящее время ЭВВ используют в качестве стандарта лечения при операци-ях коронарного шунтирования во многих отечественных и зарубежных кардиохи-рургических центрах [1,2,[4][5][6][7].…”

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“…Крупные ретроспективные исследова-ния последних лет показали, что ЭВВ не сопровождается увеличением частоты не-благоприятных кардиальных событий (та-ких, как смертность, инфаркт миокарда, реинтервенции) [3,6,13]. Однако свобода пациентов от неблагоприятных кардиаль-ных событий в подобных исследованиях свидетельствует скорее о хорошем функци-онировании маммарокоронарного шунта к передней межжелудочковой артерии, а не о сохранении проходимости аутовенозных шунтов к другим коронарным артериям.…”

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Remote patency of aortocoronary bypass grafts after endoscopic and conventional great saphenous vein harvesting

et al. 2016

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Aim. To compare patency of aortocoronary bypass grafts in remote period after endoscopic and conventional (open) great saphenous vein harvesting. To analyze the patency of aortocoronary bypass grafts after endoscopic vein harvesting from calf and thigh.Methods. The study involved 170 patients who underwent elective isolated coronary artery bypass grafting. Treatment results were evaluated in two prospectively formed groups: endoscopic (85 patients) and open (85 people) vein harvesting. Endoscopic vein harvesting was performed both from the calf and from the thigh through popliteal access using endoscopic system Vasoview 6.0. Patency of autovenous aortocoronary grafts was studied in 2.6±1.17 years after surgery using 64-slice contrast-enhanced MDCT or traditional angiography. Angiographic follow-up covered 76 patients with endoscopic vein harvesting and 79 patients with open vein harvesting.Results. The studied groups did not differ in the frequency of detection of occluded, stenotic and fully patent autovenous aortocoronary bypass grafts (p=0.841). In endoscopic vein harvesting group frequency of autovenous aortocoronary bypass grafts occlusion was 25.7%, in the group of open vein harvesting - 25.1% (p=0.984). There was no difference in the patency of internal thoracic artery grafts to the left anterior descending artery (p=0.227), and freedom from adverse cardiac events (p=0.342). Occlusion of autovenous grafts after endoscopic harvesting from the calf developed less frequently than after endoscopic harvesting from the thigh (15.1 vs. 34.6%; p=0.013). Grafts after endoscopic harvesting in the knee region occluded most often (41.9%). Patency of aortocoronary bypass grafts after open vein harvesting was not dependent on the area of the vein harvesting (p=0.900).Conclusion. Endoscopic vein harvesting does not compromise the patency of aortocoronary bypass graft and does not increase the risk of its occlusion; endoscopic harvesting of the veins from the calf improves indicators of aortocoronary grafts patency and reduces the risk of graft failure (odds ratio 0.3; 95% confidence interval 0.14-0.8; p = 0.013).

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Section: теоретическая и клиническая медицинаunclassified

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Remote patency of aortocoronary bypass grafts after endoscopic and conventional great saphenous vein harvesting

et al. 2016

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“…The effect of no-touch graft harvesting on subsequent bypass surgery outcome is difficult to evaluate, given that it represents differences in personal surgical technique and that endothelial cells cannot be directly seen or tracked following clinical graft placement. This issue is further complicated by recent advocacy of endoscopic graft harvesting approaches [22][23][24] that are primarily designed to minimize donor-site morbidity and infection and for which damage from harvesting is more difficult to control. Very few experimental studies have directly assessed endothelial preservation after vein grafting.…”

Section: Graft Ec Integritymentioning

confidence: 99%

Experimental Vein Graft Research: A Critical Appraisal of Models

Cooley¹

2015

Heart Res Open J

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Experimental models of vein grafting need to have specific relevance to the clinical complications encountered in coronary artery bypass grafting: acute thrombosis, neointimaassociated stenosis, and progression of late-forming atherosclerotic lesions. Despite extensive use, many of these experimental models lack endpoint measures with clear analogies to their clinical counterparts and may in fact target the wrong (patho) physiologic process. Model selection is critical to further progress toward preventing these all too prevalent complications used for heart revascularization.

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“…This led NICE to recommend caution in use of the endoscopic technique (57), but such concerns have now been allayed by the results of two large cohort studies. In the US study of 235 394 Medicare CABG patients in the Society of Thoracic Surgeons (STS), national database mortality rates were similar regardless of harvesting technique, while rates of harvest site complications were lower for the endoscopic technique (58). A UK study of 4702 CABG patients reported similar findings with no differences in in-hospital mortality (0.9% vs. 1.1%, p=0.71) or midterm mortality (HR 1.04; 95% CI 0.65 to 1.66) for endoscopic versus open vein harvesting (59).…”

Section: Secondary Prevention Of Stable Coronary Diseasementioning

confidence: 99%

Almanac 2013-stable coronary artery disease

Islam

2014

Anadolu Kardiyol Derg

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ALMANAC series 219Coronary heart disease in decline Epidemiological data from Europe, the USA and elsewhere in the developed world show a steep decline in coronary heart disease (CHD) mortality during the last 40 years (1). Concern about levelling of mortality rates in younger adults (2) has been somewhat alleviated by data from The Netherlands showing that in men aged <55 years, rates of decline have again accelerated, increasing from only 16% in 1993-1999 to 46% in 1999-2007 (3). A similar pattern was observed in young women with rates of decline of 5% and 38% during the same time periods. This is encouraging, particularly in the context of data from Denmark and the UK showing declining mortality and also a sharp fall in standardised incidence rates for acute myocardial infarction indicating that coronary prevention, as well as acute treatments, has contributed to recent mortality trends (4, 5). Meanwhile an Australian study reminds us that myocardial infarction is but one of several manifestations of cardiovascular disease by reporting that decreasing incidence and recurrence rates for hospitalised CHD from 2000 to 2007 have also been seen for cerebrovascular and peripheral arterial disease (6).However, the epidemiological news is not all good, and data from the UK show that the pernicious relationship between socioeconomic status (SES) and CHD has shown no tendency to go away in recent years, the gradients between top and bottom SES quintile groups for hospital admissions remaining essentially unchanged across the age range (7). Whether this has contributed to the almost 3-fold risk of myocardial infarction associated with stillbirth and 9-fold risk associated with recurrent miscarriage in a recent German study is unclear because the investigators made no adjustment for SES (8). Nor is it clear if SES has contributed to the persistent ethnic differences in both US and UK studies of CHD mortality although other factors appear also to be important. Thus, African-American men have greater exposure to CHD risk factors than Caucasians and, when adjustment is made for this, their susceptibility to CHD is no greater, although mortality rates are twice as high (9). For African-American women, incidence and mortality rates are higher than their Caucasian counter-parts. These findings suggesting that exposure to risk factors contributes to ethnic differences in the incidence of CHD are to some extent reflected in a recent report from the Health Survey for England in which 13 293 Caucasian and 2120 S Asians consented to mortality followup (10). Physical inactivity increased susceptibility to disease and not by increased case-fatality rates (11). Diagnosis of stable coronary artery diseaseThe recent AHA/ACC guideline update (12) emphasised the importance of individualising the diagnostic workup based on the estimated probability of coronary artery disease. In this respect, it mirrored an earlier National Institute of Clinical Excellence (NICE) guideline on chest pain diagnosis (13), but there were important differences ...

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Association Between Endoscopic vs Open Vein-Graft Harvesting and Mortality, Wound Complications, and Cardiovascular Events in Patients Undergoing CABG Surgery

Cited by 88 publications

References 36 publications

Remote patency of aortocoronary bypass grafts after endoscopic and conventional great saphenous vein harvesting

Remote patency of aortocoronary bypass grafts after endoscopic and conventional great saphenous vein harvesting

Experimental Vein Graft Research: A Critical Appraisal of Models

Almanac 2013-stable coronary artery disease

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