Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting

Abstract

This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=12) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P>0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P>0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06,P>0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, i 0.05), vessel dysfunction rate (11.25% vs. 11.11%,P>0.05) and mortality (0.00% v . 0.00%, P>0.05). Use of EVH was associated with significant reduction of total harvesting time (41 ±6 min vs. 63± 11 min, P<0.05), incision length (4.4±1.1 cm 18.2±4.5 cm, P<0.05) and postoperative lower extremity complications (P<0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.

Keywords

minimally invasive endoscopy / saphenous vein harvesting / obesity / coronary artery bypass grafting

References

[1] KolhP, WindeckerS, AlfonsoF, et al.. 2014 esc/eacts guidelines on myocardial revascularization: The task force on myocardial revascularization of the european society of cardiology (esc) and the european association for cardio-thoracic surgery (eacts). Developed with the special contribution of the european association of percutaneous cardiovascular interventions (eapci). Eur J Cardiothorac Surg, 2014, 46(4): 517-592

[2] TaggartDP, D’ amicoR, AltmanDG. Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875

[3] VirmaniR, AtkinsonJB, FormanMB. Aortocoronary saphenous vein bypass grafts. Cardiovasc Clin, 1988, 18(2): 41-62

[4] HeadSJ, BorgermannJ, OsnabruggeRL, et al.. Coronary artery bypass grafting: Part 2-optimizing outcomes and future prospects. Eur Heart J, 2013, 34: 2873-2886

[5] LumsdenAB, EavesFF, OfenlochJC, et al.. Subcutaneous, video-assisted saphenous vein harvest: Report of the first 30 cases. Cardiovasc Surg, 1996, 4(6): 771-776

[6] AllenK, ChengD, CohnW, et al.. Endoscopic vascular harvest in coronary artery bypass grafting surgery: A consensus statement of the international society of minimally invasive cardiothoracic surgery (ismics) 2005. Innovations (Phila), 2005, 1(2): 51-60

[7] AllenKB, HeimansohnDA, RobisonRJ, et al.. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surg Forum, 2000, 3(4): 325-330

[8] CarpinoPA, KhabbazKR, BojarRM, et al.. Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass graffing. J Thorac Cardiovasc Surg, 2000, 119(1): 69-75

[9] ZhengW, MclerranDF, RollandB, et al.. Association between body-mass index and risk of death in more than 1 million asians. New Engl J Med, 2011, 364(8): 719-729

[10] BrozekJ, GrandeF, AndersonJT, et al.. Densitometrie analysis of body composition: Revision of some quantitative assumptions. Ann N Y Acad Sci, 1963, 110: 113-140

[11] ZhengMX, ZhengLB, YangQ, et al.. Preliminary exploration of obesity evaluation standard of Jianghuai Han by skinfold thickness and body fat ratio. J Tianjin Nor Uni (Chinese), 2013

[12] DownieWW, LeathamPA, RhindVM. et al, 1978, 37(4): 378-381

[13] KrishnamoorthyB, CritchleyWR, GloverAT, et al.. A randomized study comparing three groups of vein harvesting methods for coronary artery bypass grafting: Endoscopic harvest versus standard bridging and open techniques. Interact Cardiovasc Thorac Surg, 2012, 15(2): 224-228

[14] SchultzSC, StapletonD, D’ambraP, et al.. Prospective randomized study comparing the teleflex medical saphlite retractor to the ethicon cardiovations clearglide endoscopic system. J Cardiothorac Surg, 2006, 1: 24

[15] CeresaF, PataneF. Minimally invasive nonendoscopic vein harvest using a laryngoscope. A preliminary experience. Interact Cardiovasc Thorac Surg, 2010, 10(2): 312-314

[16] MarkarSR, KuttyR, EdmondsL, et al.. A metaanalysis of minimally invasive versus traditional open vein harvest technique for coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg, 2010, 10(2): 266-270

[17] DaceyLJ. Endoscopic vein-graft harvest is safe for cabg surgery. JAMA, 2012, 308(5): 512-513

[18] WilliamsJB, PetersonED, BrennanJM, et al.. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing cabg surgery. JAMA, 2012, 308(5): 475-484

[19] LuckrazH, CartwrightC, NagarajanK, et al.. Major adverse cardiac and cerebrovascular event and patients’ quality of life after endoscopic vein harvesting as compared with open vein harvest (maqeh): A pilot study. Open Heart, 2018

[20] Wipke-TevisDD, StottsNA, SkovP, et al.. Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions. Heart Lung, 1996, 25(2): 108-116

[21] MengZH, WangYQ, SongQW, et al.. Comparison of 10 obesity determination standards at home and abroad. Zhongguo Gonggong Weisheng (Chinese), 1995, 4: 147-149

[22] GrantSW, GraysonAD, ZachariasJ, et al.. What is the impact of endoscopic vein harvesting on clinical outcomes following coronary artery bypass graft surgery. Heart, 2012, 98(1): 60-64

[23] DeppeAC, LiakopoulosOJ, ChoiYH, et al.. Endoscopic vein harvesting for coronary artery bypass grafting: A systematic review with meta-analysis of 27, 789 patients. J Surg Res, 2013, 180(1): 114-124

[24] DesaiP, KianiS, ThiruvanthanN, et al.. Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency. Ann Thorac Surg, 2011, 91(5): 1385-1391

[25] ZenatiMA, ShroyerAL, CollinsJF, et al.. Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. J Thorac Cardiovasc Surg, 2011, 141(2): 338-344

[26] Suarez–PierreA, TerasakiY, MagruderJT, et al.. Complications of CO2 insufflation during endoscopic vein harvesting. J Card Surg, 2017, 32(12): 783-789

[27] LopesRD, HafleyGE, AllenKB, et al.. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med, 2009, 361(3): 235-244

[28] SastryP, RiviniusR, HarveyR, et al.. The influence of endoscopic vein harvesting on outcomes after coronary bypass grafting: A meta-analysis of 267, 525 patients. Eur J Cardiothorac Surg, 2013, 44(6): 980-989

[29] FerdinandFD, MacdonaldJK, BalkhyHH, et al.. Endoscopic conduit harvest in coronary artery bypass grafting surgery: An ismics systematic review and consensus conference statements. Innovations (Phila), 2017, 12(5): 301-319