Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass

Zenati, Marco A.; Bhatt, Deepak L.; Bakaeen, Faisal G.; Stock, Eileen M.; Biswas, Kousick; Gaziano, J. Michael; Kelly, Rosemary F.; Tseng, Elaine; Bitondo, Jerene; Quin, Jacquelyn A.; Almassi, G. Hossein; Haime, Miguel; Hattler, Brack G.; DeMatt, Ellen; Scrymgeour, Alexandra; Huang, Grant D.

doi:10.1056/nejmoa1812390

Cited by 99 publications

(81 citation statements)

References 25 publications

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“…A number of studies have previously compared endoscopic versus open harvesting, mostly with regard to saphenous vein graft [23]. A post hoc analysis from the PREVENT IV trial showed higher risk of graft failure following endoscopic versus open harvesting of the saphenous vein (OR 1.41, 95% CI 1.16-1.71), although the trial itself was not adequately powered to detect significant differences between the 2 techniques [24].…”

Section: Discussionmentioning

confidence: 99%

Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Gaudino

Lorusso

Ohmes

et al. 2019

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Both the open and endovascular techniques are commonly used for harvesting the radial artery (ORAH and ERAH, respectively), and yet, very little is known about the effects of these 2 techniques on endothelial integrity and function of the radial artery (RA). The aim of this study was to assess the endothelial integrity and function of RA harvested using the 2 approaches. METHODS Two independent surgical teams working in the same institution routinely use the RA for coronary artery bypass grafting exclusively employing either ORAH or ERAH. Thirty-nine consecutive patients were enrolled in this comparative study. Endothelial function after ORAH or ERAH was assessed by using the wire myograph system. The integrity of the RA endothelium was evaluated by immunohistochemical staining for erythroblast transformation specific-related gene. RESULTS The vasodilation in response to acetylcholine was significantly higher in RA harvested with ORAH (P ≤ 0.001 versus ERAH). Endothelial integrity was not different between the 2 groups. CONCLUSIONS ORAH is associated with a significantly higher endothelium-dependent vasodilation. Further investigation on the potential implications of these findings in terms of graft spasm and patency as well as clinical outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Gaudino

Lorusso

Ohmes

et al. 2019

Interactive CardioVascular and Thoracic Surgery

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“…A few years later, a meta‐analysis of 267 525 patients by Sastry et al 13 proved that there was no evidence of a statistically significant difference in vein graft stenosis or occlusion comparing openly and endoscopically harvested veins from randomized studies. It was in 2019 that REGROUP trial, 14 a multicenter randomized trial including 1150 patients, cleared up this topic. The investigators found no difference between open and endoscopic vein graft harvesting regarding major adverse cardiac events (mortality, myocardial infarction, or repeat revascularization) over a median follow‐up of 2.78 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, they confirmed that endoscopic harvesting led to better harvest‐site healing. The crucial point for these results was the expertise of harvesters who had performed more than 100 endoscopic vein harvesting cases achieving a certified low conversion rate to open harvesting during a minimum 2‐year period (<5%) 14 . As a result, provided that there was a lack of experience of ours in endoscopic vein harvesting, we chose the open technique to minimize the possibilities of inadvertent, mechanical injury of venous endothelium.…”

Section: Discussionmentioning

confidence: 99%

Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?

et al. 2020

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Introduction: Despite their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits to achieve complete revascularization during coronary artery bypass grafting (CABG). Although vein storage critically impairs endothelial integrity, contradictory data concerning optimal storage solutions exist.The aim of this study is to explore any in vitro impact of cardioplegic solutions and temperature on vein grafts endothelial integrity during their storage. Materials and Methods:A single-center, prospective trial including 40 consecutive patients was conducted. Eligibility criteria included patients submitted to CABG receiving at least one vein graft. An excess segment of the graft was harvested and divided into four different parts. Each one of them was stored under different conditions; either in a conventional heparin-enriched blood solution or in a cardioplegic solution, at room temperature (20°C-22°C) and in the refrigerator (5°C).Endothelial integrity was evaluated via immunohistochemistry using an antibody against CD31.Results: Endothelial integrity (measured in a scale from 1-worst to 5-best) was significantly better after cardioplegic solution storage (2.83 ± 0.15 and 3.10 ± 0.13 in cold and room temperature, respectively) compared with storage in conventional solutions (2.23 ± 0.16 and 2.0 ± 0.15 in cold and room temperature, respectively).A significant effect of cardioplegic storage solution, as well as of cold temperature and cardioplegic solution interaction on endothelial preservation was reported, whereas storage temperature did not prove a significant factor by its own. Conclusions: Cardioplegic storage solutions result in significantly better endothelial preservation compared with conventional heparin-enriched blood solutions. The association with superior clinical outcomes remains to be proved. K E Y W O R D S cardioplegic solution, coronary artery bypass grafting, saphenous vein graft, storage solutions, vein graft failure 1272-7990 How to cite this article: Papakonstantinou NA, Sykaras AG, Vourlakou C, Goudevenos J, Papadopoulos G, Apostolakis E. Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium? J Card Surg. 2020;35:996-1003.

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“…This method of harvesting reduces leg wound complications such as infection, pain, and numbness, as well as improving cosmetic results. EVH was rapidly adopted and is now used in many centres worldwide and in the majority of CABG operations in the United States of America [65] . Whereas the extensive skin incisions used in open vein harvesting (OVH) allow removal with minimal surgical trauma to the conduit, there is a risk of higher local wound complications.…”

Section: Endoscopic Vein Harvestingmentioning

confidence: 99%

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Samano¹,

Souza²,

Pinheiro³

et al. 2020

Braz J Cardiovasc Surg

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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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Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass

Cited by 99 publications

References 25 publications

Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

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