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      Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad

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          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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          Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery.

          Nicholas Kouchoukos, G Hafley, Karen Peterson … (2009)
          Vein-graft harvesting with the use of endoscopy (endoscopic harvesting) is a technique that is widely used to reduce postoperative wound complications after coronary-artery bypass grafting (CABG), but the long-term effects on the rate of vein-graft failure and on clinical outcomes are unknown. We studied the outcomes in patients who underwent endoscopic harvesting (1753 patients) as compared with those who underwent graft harvesting under direct vision, termed open harvesting (1247 patients), in a secondary analysis of 3000 patients undergoing CABG. The method of graft harvesting was determined by the surgeon. Vein-graft failure was defined as stenosis of at least 75% of the diameter of the graft on angiography 12 to 18 months after surgery (data were available in an angiographic subgroup of 1817 patients and 4290 grafts). Clinical outcomes included death, myocardial infarction, and repeat revascularization. Generalized estimating equations were used to adjust for baseline covariates associated with vein-graft failure and to account for the potential correlation between grafts within a patient. Cox proportional-hazards modeling was used to assess long-term clinical outcomes. The baseline characteristics were similar between patients who underwent endoscopic harvesting and those who underwent open harvesting. Patients who underwent endoscopic harvesting had higher rates of vein-graft failure at 12 to 18 months than patients who underwent open harvesting (46.7% vs. 38.0%, P<0.001). At 3 years, endoscopic harvesting was also associated with higher rates of death, myocardial infarction, or repeat revascularization (20.2% vs. 17.4%; adjusted hazard ratio, 1.22; 95% confidence interval [CI], 1.01 to 1.47; P=0.04), death or myocardial infarction (9.3% vs. 7.6%; adjusted hazard ratio, 1.38; 95% CI, 1.07 to 1.77; P=0.01), and death (7.4% vs. 5.8%; adjusted hazard ratio, 1.52; 95% CI, 1.13 to 2.04; P=0.005). Endoscopic vein-graft harvesting is independently associated with vein-graft failure and adverse clinical outcomes. Randomized clinical trials are needed to further evaluate the safety and effectiveness of this harvesting technique. 2009 Massachusetts Medical Society
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            Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients.

            Thorsten Wahlers, Yeong-Bin Choi, Ingo Slottosch … (2013)
            To determine the current strength of evidence for or against endoscopic vein harvesting (EVH) in patients undergoing coronary artery bypass grafting (CABG). A meta-analysis of randomized controlled trials (RCT) and observational trials (OT) was performed that reported the impact of EVH on adverse clinical outcomes after CABG. Analyzed postoperative outcomes included wound infection, postoperative pain, myocardial infarction (MI), vein graft failure, length of hospital stay, and mortality. Pooled treatment effects (OR or weighted mean difference (WMD), 95%CI) were assessed using a fixed or random effects model. A total of 27,789 patients from 43 studies (16 RCT, 27 OT) were identified who underwent saphenectomy by endoscopic (46%; n = 12,822) or conventional technique (54%; n = 14,967). Pooled effect estimates revealed a reduced incidence (P < 0.001) for wound infections (OR 0.27; 95% CI 0.22 to 0.32), pain (WMD -1.26, 95% CI -2.07 to -0.44; P = 0.0026), and length of hospital stay (WMD -0.6 d, 95% CI -1.08 to -0.12; P = 0.0152). EVH was associated to an increase of the odds for vein graft failure (OR 1.38; 95% CI 1.01 to 1.88; P = 0.0433), a finding that lost statistical difference after pooled analysis of RCT and studies with high methodological quality. Similarly, graft-related endpoints, including mortality and MI, did not differ between the harvesting techniques. The present systematic review underscores the safety of EVH in patients undergoing CABG. EVH reduces leg wound infections without increasing the midterm risk for vein graft failure, MI, or mortality. Copyright © 2013 Elsevier Inc. All rights reserved.
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              Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting.

              Petros Skapinakis, B Perunovic, Omer Aziz … (2003)
              The great saphenous vein remains the most commonly harvested conduit for revascularization in coronary artery bypass grafting (CABG). Our aim is to compare minimally invasive vein harvest techniques to conventional vein harvest with regards to leg wound infection rates. A meta-analysis of identified randomized controlled trials, reporting a comparison between the two techniques published between 1965 and 2002, was undertaken. The outcome of interest was leg wound infection. Fourteen randomized studies were identified and included in the meta-analysis. Our study revealed that wound infection was significantly lower in the minimally invasive vein harvest group (odds ratio 0.22 with 95% confidence intervals of 0.14 to 0.34). Our study suggests that using minimally invasive techniques might reduce leg wound infection rate following great saphenous vein harvesting for CABG. Further research is required to evaluate the potential benefits of minimally invasive vein harvesting techniques on the cost of postoperative care and quality of the harvested vein.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electron Physician
                Journal ID (iso-abbrev): Electron Physician
                Journal ID (publisher-id): Electronic physician
                Title: Electronic Physician
                Publisher: Electronic physician
                ISSN (Electronic): 2008-5842
                Publication date Collection: January 2016
                Publication date (Electronic): 15 January 2016
                Volume: 8
                Issue: 1
                Pages: 1693-1700
                Affiliations
                [1 ]M.D., Assistant Professor, Department of Cardiac Surgery, Faculty of Medicine, Birjand University of Medical Science, Birjand, Iran
                [2 ]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
                [3 ]M.D., Associate Professor, Department of Anesthesiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
                [4 ]Medical Student, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
                [5 ]M.D., Assistant Professor, Department of Cardiac Surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
                [6 ]M.D., Assistant Professor, Department of Pediatric Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran
                [7 ]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
                Author notes
                Corresponding author: Assistant Professor Dr. Aliasghar Moeinipour. Department of Cardiac Surgery, Faculty of Medicine, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran. Tel: +98.5138022321, Fax: +98.5138525307, Email: moinipoora1@ 123456mums.ac.ir
                Article
                Publisher ID: epj-08-1693
                DOI: 10.19082/1693
                PMC ID: 4768916
                PubMed ID: 26955438
                SO-VID: 0beeba6c-6b37-4e59-8592-76eaf9fd5d8f
                Copyright © © 2016 The Authors
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 23 September 2015
                Date accepted : 27 November 2015
                Categories
                Subject: Original Article

                Keywords: endoscopic vein harvesting,open vein harvesting,coronary artery bypass grafting,graft patency,clinical outcome,pathological outcome
                Data availability:
                Keywords: endoscopic vein harvesting, open vein harvesting, coronary artery bypass grafting, graft patency, clinical outcome, pathological outcome

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