常规切口、分段小切口、内窥镜下采集大隐静脉在冠脉旁路移植中的应用比较

目的 比较常规切口、分段小切口、内窥镜下大隐静脉采集法的应用.方法 将96例择期冠脉旁路移植(CABG)患者分为常规切口组、分段小切口组、内窥镜组,分别采集大隐静脉.比较术中资料及术后下肢并发症的发生率.结果 大隐静脉长度3组间无明显差别(P>0.05);切口总长度分段小切口组与内窥镜组均明显短于常规切口组(P<0.01),且内窥镜组明显短于分段小切口组(P<0.01);大隐静脉采集时间内窥镜组与分段小切口组均长于常规切口组(P<0.01);而大隐静脉总手术时间3组间无统计学意义;下肢并发症常规切口组明显高于其他两组(P<0.05).结论 分段小切口和内窥镜下采集大隐静脉创伤小、并发症发生率低,可以作为CABG理想的大隐静脉采集方法.     

高龄CABG患者常规切开与内窥镜法采集大隐静脉下肢并发症的对比研究

【】 目的 对比高龄冠状动脉旁路移植术(CABG)患者常规切开与内窥镜法采集大隐静脉下肢并发症的发生情况,评价内窥镜下采集大隐静脉用于高龄CABG患者的临床效果。方法 选取2014年06月至2015年12月于我院行冠状动脉旁路移植术高龄患者196 例,分为内窥镜静脉采集组(EVH 组,98 例)和常规切开静脉采集组(CVH 组,98例),比较两种静脉采集方法的术后下肢并发症的情况。 结果 与CVH组相比,EVH组在切口长度、术后疼痛评分、术后并发症和住院时间均小于CVH组,两组差异具有统计学意义(P＜0.05);两组采集的大隐静脉质量、总手术时间及住院费用等方面差异无统计学意义(P＞0.05)。结论 应用内窥镜采集大隐静脉能够明显降低高龄患者冠状动脉旁路移植术后下肢并发症的发生率,早期效果满意。内窥镜采集大隐静作为一种微创取血管的方法,对于高龄冠状动脉旁路移植术患者是安全的和值得推荐的。     

腔镜辅助下取大隐静脉方法在冠状动脉旁路移植术中的应用

目的:探讨腔镜辅助下切取大隐静脉在冠状动脉旁路移植术(CABG)患者中应用的可行性、安全性及疗效,并与传统方法取大隐静脉进行比较。方法:我科48例应用大隐静脉CABG的患者中,采用传统方法切取大隐静脉26例(Ⅰ组),腔镜辅助下取大隐静脉22例(Ⅱ组)。比较两组患者一般情况及取大隐静脉时间、所取大隐静脉长度、术后下肢切口疼痛需应用镇痛药、下肢局部麻木、下肢切口愈合不良及下肢切口周围瘀斑等方面的差异。结果:两组患者一般情况无明显差异;两种方法对大隐静脉均无损伤,取材大隐静脉长度无明显区别,Ⅰ组取大隐静脉时间小于Ⅱ组(P0.05),Ⅱ组术后下肢切口疼痛需应用镇痛药例数、下肢局部麻木例数、下肢切口愈合不良及下肢切口周围瘀斑均小于Ⅰ组(均P0.05)。结论:腔镜辅助下取大隐静脉是安全可行的,其手术时间相对较长,但其切口美观,创伤小,且能明显减少传统方法的腿部并发症。     

内窥镜采集大隐静脉行冠状动脉旁路移植术患者的术后并发症处理策略

目的 回顾性分析内窥镜采集大隐静脉(EVH)行冠状动脉旁路移植术(CABG)患者的术后并发症及处理经验。方法 2014年1月至2015年1月我科采用内窥镜采集大隐静脉做为CABG血管材料患者352例。手术方式非体外循环下冠状动脉旁路移植手术317例,体外循环下冠状动脉旁路移植手术35例,其中单纯冠状动脉旁路移植手术3例,同期行二尖瓣成形18例,二尖瓣置换6例,主动脉瓣置换6例,室壁瘤切除、左室成形2例。结果 术后并发症包括：心房颤动18例,低心排出量综合征10例,围术期心肌梗死6例,低氧血症6例,精神异常3例,皮下隧道内血肿、下肢肿胀疼痛3例,皮肤灼伤2例。术后死亡4例 (1.13%),原因为低心排出综合征合并多脏器功能衰竭2例、心室颤动1例,大面积脑梗死l例。结论 加强术后监护及治疗,及时纠正低心输出量综合征,积极防治术后心律失常等均为提高手术成功率的关键因素。应用内窥镜采集大隐静脉行冠状动脉旁路移植术患者术后并发症发生率低,其作为一种微创取血管的方法,是安全和值得推荐的大隐静脉采集方法。     

内窥镜获取大隐静脉技术在非体外冠状动脉旁路移植术的临床应用

目的:总结内窥镜获取大隐静脉技术(EVH)在非体外冠状动脉旁路移植手术(CABG)的应用以及早中期结果。方法:回顾分析2010年8月至2013年12月间,北京安贞医院心脏外科11病区73例采用内窥镜获取大隐静脉技术的CABG术早期、中期结果。结果:下肢切口为(4.0±2.0)cm;大隐静脉取材长度(32.1±6.8)cm,获取时间为(50.0±12.9)分钟。静脉壁损伤需要7-0Prolene线修补的漏口数平均为1.3个。1例术中转为开放获取大隐静脉,所有患者术后无下肢切口感染。围手术期无心肌梗死、脑卒中以及死亡事件发生。随访65例,随访时间1~34个月。冠状动脉CTA显示大隐静脉总体通畅率为86.0%。结论:内窥镜获取大隐静脉技术可能带来良好的早期和中期效果。     

加压试验在采集大隐静脉桥血管中的应用

目的观察加压试验在采集大隐静脉桥血管中的应用及安全性。方法选择我院2012年10月—2015年9月行冠状动脉旁路移植术(CABG)中应用加压试验采集大隐静脉桥血管病例126例,男81例,女45例;年龄33岁~81岁。术中使用桥血管采集左乳内动脉及大隐静脉,采集大隐静脉时应用加压试验间断小切口。术中观察桥血管大体质量及术后效果进行相关性分析。结果全组126例病人良好,术中应用加压试验顺利,桥血管无破损,术后无因静脉桥血管质量而发生大出血病例,其中1例皮下瘀血,经引流后好转,无切口感染病例,术后随访无近期心血管事件发生。结论 CABG已成熟,且大隐静脉桥血管采集方法较多,但大隐静脉桥血管的质量及远期效果有待进一步研究。     

No-touch与EVH获取大隐静脉桥血管的近中期临床结果分析

目的 比较no-touch和内窥镜获取（endoscopic vein harvesting, EVH）两种不同的大隐静脉移植物获取方式对冠状动脉旁路移植术（coronary artery bypass grafting, CABG）术后早期临床效果及近中期移植物通畅率的影响。 方法 回顾性分析西安交通大学第一附属医院心血管外科2018年7月至2019年12月行CABG患者151例,其中no-touch技术组获取大隐静脉56例;EVH组获取大隐静脉95例。所有患者采取胸骨正中切口入路,非体外或体外循环辅助下完成搭桥手术。统计两组间平均桥血管远端吻合口数量、左乳内动脉吻合口数量及静脉桥远端吻合数量的差异;分析比较两组术后死亡及早期并发症发生情况以及术后切口并发症如血肿、脂肪液化等差异。患者出院前及术后1年行冠脉动脉CT血管成像检查（CTA）以评估移植血管桥近中期的通畅情况。 结果 No-touch和EVH两组在年龄、性别构成、危险因素、术前诊断类型等方面均无统计学差异。术中两组左乳内动脉吻合口数量及静脉桥远端吻合数量等差异均无统计学意义。两组均无手术死亡。在术后早期并发症方面无显著性差异;但在下肢切口并发症中水肿、切口处麻木、疼痛在no-touch组中尤为显著（P<0.05）。术后冠脉CTA复查提示,术后早期桥血管总体通畅率、两组间左乳内动脉及大隐静脉桥血管通畅率均无差异。术后1年总体桥血管通畅率no-touch组要优于EVH组（P<0.05）,其中左乳内动脉通畅率无差异,大隐静脉桥血管no-touch组通畅率要明显高于EVH组（P<0.05）。 结论 No-touch技术获取静脉桥血管对于CABG患者的近、中期临床效果满意,且中期桥血管通畅率要优于EVH组。该技术可行、安全、有效,值得在CABG中进一步推广。     

内窥镜采集大隐静脉在冠状动脉旁路移植术后近、中期的疗效分析

目的比较冠状动脉旁路移植术（CABG）中应用内窥镜采集与直视切开采集大隐静脉的近、中期临床效果。方法纳入2005年4月~2010年1月行CABG治疗且随访资料完整的冠心病患者268例。根据大隐静脉的采集术式分为两组,使用内窥镜采集大隐静脉的患者进入内镜组（EVH组,n=129）,采用直视切开采集大隐静脉的患者进入切开组（OVH组,n=139）,应用64排螺旋CT（64-MSCT）对比分析手术后3个月、1年、3年大隐静脉桥通畅率。结果 EVH组与OVH组术后3个月、1年、3年大隐静脉桥通畅率均无统计学差异[分别为（88.0%vs.85.6%）,（78.9% vs.79.9%）,（72.2% vs.71.8%）, P＜0.05],但EVH组采集时间更长[（50.23±5.87）min vs.（38.65±7.96）min],破损情况更多[（1.51±0.19） vs.（0.84±0.04）],差异有统计学意义（P＜0.05）。结论内窥镜和直视切开两种采集方式的大隐静脉桥近、中期通畅率接近,但内窥镜法采集时间较长,静脉破损较多。     

内窥镜获取大隐静脉在冠状动脉旁路移植术中的临床研究

目的分析比较内窥镜与传统开放式获取大隐静脉应用于冠状动脉旁路移植术(CABG)的早期临床效果。方法纳入2010年3月至2013年1月298例采用内窥镜静脉采集法(EVH)行CABG的患者(EVH组),并与同期309例采用传统切开静脉采集法(CVH)行CABG的患者(CVH组)进行比较,对比两组患者术前资料、手术情况和术后并发症。结果两组患者在获取静脉时间、获取静脉长度、静脉桥数、总手术时间、术后住院时间以及切口感染或延迟愈合、切口血肿、局部皮肤坏死、皮炎发生率等方面比较,差异均无统计学意义(均P0.05);而EVH组患者住院期间腿部疼痛(17.4%比51.1%,P=0.000)、住院期间腿部水肿(0.7%比32.7%,P=0.000)及淋巴漏(0比7.4%,P=0.000)发生率均显著低于CVH组,差异有统计学意义。结论 CABG术中应用EVH能够显著减轻创伤,降低术后并发症的发生率。     

间断小切口与长切口大隐静脉取法的临床对比研究

目的探讨冠状动脉旁路移植术(CABG)间断小切口与长切口两种取大隐静脉方法的优缺点.方法将40例CABG患者随机分为两组,每组20例,一组采用间断小切口取大隐静脉(间断小切口组),另一组采用长切口取大隐静脉(长切口组).术后10天观察切口情况,随访1～9个月,对比观察、分析临床结果.结果间断小切口组术后10天,2例切口血肿(10%).随诊中1例血肿需外科处理.长切口组术后10天,共7例(35%)患者切口发生并发症,随访中2例患者因感染需外科处理.结论间断小切口技术虽然较长切口复杂、困难,但在减少术后并发症和提高术后美容上优于长切口.     

Prediction of and risk factors for surgical wound infection in the saphenous vein harvesting leg in patients undergoing coronary artery bypass

BACKGROUND: Surgical wound infection (SWI) of the leg after saphenous vein harvesting is an important complication of coronary artery bypass graft (CABG) procedures. SWIs may restrict mobility in the postoperative period and increase costs of postoperative hospitalisation and antibiotic treatment. METHODS: A total of 356 patients were followed. Surgical risk factors were evaluated for SWI following saphenous vein harvesting, and the effectiveness of an occlusive glycerinated hydrogel dressing in reducing postoperative SWIs was assessed. In addition, the ability of postoperative clinical wound assessment to predict SWI following CABG 30 and 60 days after operation was investigated. RESULTS: The most important risk factor for SWI after saphenous vein harvesting was the use of a monofilament suture for skin closure (glycomer 4-0 Biosyn Tyco Healthcare, Stockholm, Sweden) (p > 0.001). The hydrogel dressing did not prevent the development of SWIs. The clinical wound assessment showed that wound gap was associated with leg infection, but other signs were poor predictors of SWI. CONCLUSION: The choice of suture and suturing technique is important to prevent SWI following saphenous vein harvesting. More precise definitions of wound signs are necessary if they are to be used as predictors of SWI.     

Postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting for coronary artery bypass grafting - a prospective analysis

BACKGROUND: We sought to determine whether the postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting are comparable. METHODS: From February 2004 to September 2006, 120 patients underwent minimally invasive vein harvesting, and subsequently 150 patients had endoscopic vein harvesting for CABG. Patients were evaluated prospectively for wound-healing disturbances, residual leg oedema, pain intensity and saphenous neuropathy on the 7th postoperative day and after 3 months. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, minimally invasive vein harvesting was associated with a significantly higher incidence of residual oedema (28 % vs. 13 %; P < 0.05), (19 % vs. 6 %; P < 0.001), pain (20 % vs. 9 %; P < 0.05), (10 % vs. 6 %; P < 0.05), and saphenous neuropathy (23 % vs. 7 %; P < 0.001) (14 % vs. 3 %; P < 0.001) during follow-up on the 7th postoperative day as well as 3 months after surgery, respectively. Mean harvesting time (40.6 +/- 15.5 vs. 43.9 +/- 10.2 min; P = 0.09), conversion rate (3 % vs. 2 %; P = 0.71), and injury per conduit (0.3 +/- 0.2 vs. 0.3 +/- 0.1; P = 0.91) were comparable for both groups. CONCLUSIONS: Endoscopic vein harvesting seems to be superior to minimally invasive vein harvesting in terms of a significant reduction of residual leg oedema, pain intensity and particularly saphenous neuropathy in the postoperative and midterm follow-up.     

Does No-Touch Technique Better than Conventional or Intermediate Saphenous Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a Systematic Review and Meta-analysis

Saphenous vein (SV) is a common graft being used in coronary artery bypass grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT) are the most common harvesting techniques of SV for CABG. The aim of this study is to systematically review the NT versus CON and I techniques in harvesting SV for CABG. Twelve databases were searched for randomized controlled trials comparing the CON, I, and NT techniques in harvesting SV for CABG. Twelve reports of six RCTs were included. Our meta-analysis showed that with NT technique, patency rate was significantly higher when compared to I technique up to 18-month follow-up duration. In contrast, this significant difference was not maintained in terms of minor complications of leg wounds with both techniques. The NT has significantly higher patency rate compared to I vein harvesting technique. However, more RCTs are warranted to confirm these results.     

"Endoscopic Saphenous Vein Harvest Decreases Leg Wound Complication in Coronary Artery Bypass Grafting Patients"

A bstract Background: Coronary artery bypass grafting (CABG) is the most common procedure performed in adult cardiovascular surgery. The most frequently used conduit is the greater saphenous vein. Using traditional methods, the complication rate of the leg is relatively high (up to 24%). To decrease the complication rate, we used the Endo-Path to harvest the greater saphenous vein. Methods and Results: From May 1997 through March 1999, a total of 135 patients received the CABG operation. We excluded the patients who died immediately postoperatively or had concomitant surgical procedures. Sixty patients received the endoscopic saphenous vein harvest procedure (group A), while another 59 patients (group B) did not. No important differences were noted between the two groups in respect to the number of distal anastomoses, length of harvested vein, total surgical time, and length of ICU stay. However, the leg wound complication rate decreased from 20.3% to 5.0% (p < 0.001). Conclusions: Although the long-term patency rate needs time to be proven, the endoscopic greater saphenous vein harvest method is an attractive and effective method.     

Postoperative and mid-term wound disturbance outcomes of minimally invasive saphenous vein harvest using the VEGA system

Great saphenous vein harvest is associated with a significant risk of impaired wound healing. The purpose of this study was to determine efficacy of one system designed for minimally invasive vein harvest (MIVH) and to assess postoperative and mid-term wound-healing disturbances. From February 2004 to June 2005, great saphenous harvest for coronary artery bypass grafting (CABG) was performed in a group of 120 consecutive patients employing the VEGA system (B/Braun-Aesculap, Tuttlingen, Germany). Patients were evaluated on 7th postoperative day, at the 3-month and 1-year follow-up for wound healing disturbances, residual leg edema, and saphenous neuropathy. The mean age was 67.3 years, male patients dominated (70%), and the leading procedure was CABG (83%). The mean number of harvested venous grafts was 1.9 ± 1.2 and the mean number of skin incisions was 3.7 ± 2.2. The mean total vein harvesting time was 40.2 ± 16.8 minutes. Satisfactory healing was achieved in 98% patients on 7th postoperative day and at the 3-month follow-up all wounds were completely healed. Saphenous neuralgia remained a significant cause of morbidity, although its incidence decreased from 25% presented on 7th postoperative day to 8% presented at 1-year follow-up. Likewise, the incidence of leg edema decreased from 34% on the 7th postoperative day to 7% at 1-year follow-up. Minimally invasive vein harvest is a safe method associated with a significant reduction of wound disturbances. The VEGA system appears to be suitable and effective equipment for MIVH. Nevertheless, residual edema and mainly saphenous neuropathy represent a relatively frequent cause of patient morbidity at the postoperative and mid-term follow-up.     

Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft

Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency.     

Harvesting of an internal saphenous graft for aorto-coronary bypass using video-surgery]

Classical excision of saphenous vein grafts requires a continuous incision on the leg or the thigh or both. To minimise the trauma due to this method, an endoscopic method has been recently developed. The aim of this paper was to assess the benefits of this new method compared with the classical technique. One hundred and twenty patients requiring aorto-coronary grafts were included in this prospective study and divided into two groups according to the method of saphenous vein harvesting. Group A comprised 60 patients who underwent the classical method os saphenous vein harvesting and Group B 60 patients who benefited from the endoscopic method. No difference was observed between the two groups with respect to mean age, sex ratio, history of diabetes and obliterative arterial disease of the lower limbs. Parsonnet index number of bypass grafts and length of vein excised. The length of the skin wound in group A was 30.8 +/- 8.5 cm compared with only 4.1 +/- 1 cm in Group B (p = 0.006) but the harvesting time was longer by endoscopy (55.7 +/- 23.7 minutes: 72.5 +/- 22.6 minutes for the first 10 patients, 48.5 +/- 24.7 minutes for the last 50 patients) compared with the classical technique (39.8 +/- 6.6 minutes: p = 0.001). Moreover, patients who underwent videosurgery had less operative pain (8% versus 15%) (p = 0.001). The number of infectious complications was slightly lower in Group B (3.3%, 2/60, versus 10%, 6/60), (NS). The authors conclude that harvesting of the saphenous vein by videosurgery reduces postoperative pain and gives a more aesthetic result but with a slightly longer operative time at the beginning of the experience.     

Comparison of the Effects of Levosimendan and Papaverine on Human Internal Mammary Artery and Saphenous Vein

Purpose  

Internal mammary artery (IMA) and saphenous vein (SV) are two most common vessels used in coronary artery bypass grafting (CABG). In the present study, the effect of levosimendan (a novel inotropic/vasodilator compound) and papaverine are compared, using IMA and SV obtained from CABG patients.