Endoscopic Harvesting Research Articles

Randomized Trial of 2 Endoscopic Radial Artery Harvesting Devices—Immunofluorescence Assessment

Various devices are available for endoscopic radial artery harvesting during coronary artery bypass grafting. Thermal spread and graft damage, however, are common concerns. The aim of this study was to compare the MiFusion TLS2 system (Endotrust, Nettetal Germany) with direct heat technique and the LigaSure Maryland system (Medtronic, Dublin, Ireland) using advanced bipolar technique in a prospective randomized study. One hundred consecutive patients undergoing coronary artery bypass grafting with endoscopic radial artery harvesting were prospectively included and randomized 1:1. The proximal (brachial) ends of the grafts were analyzed using fluorescence microscopy with focus on graft integrity. In addition, harvesting time, graft sealing, residual bleeding, and incidence of neurological disorders were compared. Patient age was 67 ± 8 years. Mean harvesting time was 26.5 ± 9 minutes for the TLS2 and 23.2 ± 8 minutes for the LigaSure (P= .049). Overall graft integrity was good in both groups. A significantly better graft integrity was observed in the LigaSure group (scale 0 to 3; 3= best) with 2.5 ± 0.6 for TLS2 and 2.8 ± 0.4 for LigaSure (P= .031). LigaSure provided significantly better graft sealing (scale 0 to 2; 0= best) with 0.6 ± 0.7 vs 1.0 ± 0.6 (TLS2) (P= .006) and less residual bleeding (scale 1 to 5; 1= best) with 1.4 ± 0.6 vs 2.0 ± 0.9 (TLS2) (P < .001). Transient sensibility disorders were less frequently observed with LigaSure (2% vs 16%, P= .015). Endoscopic radial artery harvesting can be performed with excellent results and good graft integrity using both devices. Compared with the MiFusion TLS2, the LigaSure device led to faster procedural times and resulted in better graft integrity. Along with providing a better seal, LigaSure was associated with less sensibility disorders.

CRT-400.04 Hypoxic Damage in Saphenous Veins Harvested With Conventional and Endoscopic Technique in Coronary Artery Bypass Surgery

Coronary-artery bypass grafting still represents the most successful treatment of coronary artery disease. The patency of the graft could be dependent on precise surgical technique (conventional (vsK) or endoscopic (vsE) harvesting), and potentially also on the hypoxic damage of the vein wall. The

KORONER ARTER BAYPAS OPERASYONLARINDA OTOLOG VENA SAFENA MAGNA ÇIKARILMASINDA ENDOSKOPİK, TÜNEL VE STANDART YÖNTEMİN KARŞILAŞTIRILMASI

Objective: Autologous vena saphena magna is the most common bypass material used in coronary artery surgery. It is generally prepared with a long medial leg incision, and so healing problems are often observed. In this study, we aimed to compare endoscopic, classical and tunnel techniques in saphen harvesting. Material and Method: Fourty patients, who were selected randomly and retrospectively, were included in the study. Endoscopic saphen harvesting was performed on 10 patients, the tunnel technique was performed on 15 patients and the classical method was performed on 15 patients. Postoperative hospital stay, antibiotics, additional antibiotic requirement, upper leg size, hematoma, open care time, culture antibiogram, incision size, complication site, cost, postoperative complaints, median vena saphena magna harvesting time, vena saphena magna length, closed dressing time, elastic bandage time, drenaige amount, postoperative pain scores (Visual Analogue Scale-VAS) were all factors compared regarding saphen insicion site. Results: In tunnel end endoscopic procedures; insicion length, postoperative pain, major complication rate, incision closure time, the sutur material reqired for closing incisions were lower than the classical technique group. Moreover, the level of patients’ satisfaction was increased due to perfect cosmetic results and ease of early mobilization. Conclusion: Comparing classical saphen harvesting techniques with endoscopic and tunnel methods, it was found that incision problems, length of hospital stay, sutur material amounts, incision closure time, incision length and postoperative pain were detected in lower numbers in endoscopic and tunnel methods. Depending on these factors, the patient’s mobilization time was shortened. According to these results, the superiority of the endoscopic and tunnel methods compared to the classical method should be considered.

Endoscopic versus open harvesting of radial artery for CABG

BackgroundEndoscopic harvest of the radial artery avoids long forearm incisions and has better cosmesis compared to the open technique. The objective of this study was to compare the short-term results and wound-related complications of endoscopic radial artery harvest versus open technique.ResultsFrom 2013 to 2017, 800 patients had coronary artery bypass grafting; 88 patients of them had radial artery harvesting (11%). Two groups were included in the study according to the surgeon preference, endoscopic radial harvest (group 1, n = 30; 3.75% of total CABG patients) and open harvest (group 2, n = 58; 7.25% of total CABG patients). Group 1 had more males (25 (83.33%) vs. 35 (60.34%); p = 0.028). There was no difference in the preoperative comorbidities between both groups. The duration of the harvest was significantly longer in group 1 (median 40 min ranges from 38 to 42 min vs. 49 min ranges from 47 to 52 min in groups 1 and 2, respectively; p < 0.001). The operative time was longer in group 1 (median 302.5 min ranges from 295 to 310 min vs. 277 min ranges from 273 to 280 min in groups 1 and 2, respectively; p < 0.001). The hospital stay in the endoscopic radial artery harvest group was significantly shorter than that of open technique (median 7 days ranges from 6 to 7 days vs. 7.5 days ranges from 7 to 9 days; p < 0.001). There was no significant difference in the postoperative complications between both groups. One case (3.3%) was transformed from the endoscopic to open technique due to uncontrolled bleeding. Endoscopic technique was associated with more patients presenting with hand numbness (6 cases; 20% versus 3 cases 5.2%) and radial nerve injury (2 cases; 6.6% versus none), while open technique showed more cases of local hematoma (8 cases; 13.8% versus 1 case; 3.3%) and wound infection (6 cases; 10.34% versus none); p > 0.05.ConclusionEndoscopic radial artery harvest is associated with shorter harvest time and shorter hospital stay. Endoscopic radial artery harvest is a safe technique with good short-term outcomes. Longer follow-up is recommended.

Endoscopic Radial Artery Harvesting During Anesthesia Line Placement Reduces the Time and Cost of Multivessel Coronary Artery Bypass Grafting.

Endoscopic radial artery (RA) harvesting performed concurrently with internal mammary artery (IMA) takedown and endoscopic saphenous vein (SV) harvesting creates a crowded and inefficient operating room environment. We assessed the effect of a presternotomy RA harvest strategy on surgery time and costs. A total of 41 patients underwent elective, first-time, isolated multivessel on-pump coronary artery bypass grafting including an IMA, RA, and SV graft. The first 20 patients (Phase I) underwent endoscopic RA harvesting concurrently with IMA takedown and endoscopic SV harvesting after sternotomy, requiring two sets of endoscopic harvesting equipment per case, each used by a separate individual. The final 21 patients (Phase II) underwent endoscopic RA harvesting during anesthesia line placement, completing the procedure before sternotomy, thus requiring only one set of endoscopic harvesting equipment reused by a single individual. There were no differences in baseline patient characteristics, number of bypasses, duration of SV or RA harvest time, or duration of cardiopulmonary bypass or cross-clamp time between the two groups. Total surgery time was reduced by 32 minutes in Phase II (P = 0.044). Relative to a total hospital direct cost of 100.00 units, total surgery costs were reduced from 29.33 units in Phase I to 25.62 units in Phase II (P = 0.001). No anesthesia- or RA harvest-related complications occurred in either group. Endoscopic RA harvesting can be safely performed during anesthesia line placement prior to sternotomy. Our simple but innovative strategy improves intraoperative workflow, reduces the time and cost of surgery, and advances the delivery of high-quality patient care.

Blood loss control during endoscopic vein harvesting for myocardial revascularization in patients with acute coronary syndrome

From 5 to 10% of patients presenting with acute coronary syndrome and receiving dual antiplatelet therapy require surgical myocardial revascularization. Dual antiplatelet therapy considerably increases the risk of surgical bleeding. Endoscopic harvesting of the great saphenous vein is a technique that can make it possible to decrease the injury and to minimize blood loss. The study included a total of 32 patients presenting with acute coronary syndrome and undergoing coronary artery bypass grafting. They were subdivided into two groups: Group One (study group) was composed of 17 patients subjected to endoscopic harvesting of the great saphenous vein in the flap. Group Two (comparison group) consisted of 15 patients undergoing an open technique of harvesting of the vein in the flap. During the entire perioperative period, the amount of discharge through drainages from the mediastinum did not differ significantly (958±173 ml for Group One patients and 1005±165 ml for Group Two patients, p=0.47). The amount of discharge from the bed of the great saphenous vein on the lower extremities in Group One patients turned out to be less than in Group Two patients (443±37 ml vs. 570±77 ml, p=0.04). A higher haemoglobin content in the total blood count was observed in the postoperative period in the Study Group patients (90±30 g/l vs. 74±21 g/l, respectively, p=0.03). The necessity to use donor blood preparations in Group One patients turned out to be less (transfusion of erythrocytic mass 0 and 2 (0; 2) doses, p=0.001; fresh frozen plasma 2 (0; 3) and 5 (3; 8) doses, respectively, p=0.0001). The duration of hospital stay amounted to 8±1.1 days in the study group and to 15±4.5 days in the comparison group (p<0.0001). Hence, this approach makes it possible to control blood loss in high-risk patients undergoing coronary artery bypass grafting on the background of dual antiplatelet therapy, to decrease the amount of donor blood, and to reduce the length of hospital stay.

Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg.

Antegrade endoscopic harvesting of autografts for bypass grafting may be an optimal strategy addressing excellent graft quality and reduced post-operative wound complications. This standardized protocol for antegrade endoscopic vein harvesting (EVH) from the lower leg has the potential to be introduced to routine coronary artery bypass grafting (CABG). Patients undergoing CABG surgery are positioned on a surgical table with two additional foam rollers below the extended legs, enabling antegrade EVH from the lower leg. Following minimally invasive surgical access through a bridging vein harvest technique, an endoscopic optical dissector is inserted antegrade into the wound. The main vessel and side branches are dissected under continuous optical control of vein quality status and the working channel. After, an endoscopic optical retractor is inserted with an internal bipolar electrocoagulation device for precise, safe, and tissue-protective interruption of side branches. After release of the vein, the vessel is cut off at the proximal and distal ends under optical control, retrieved from the wound, then cannulated and flushed with heparinized saline. Finally, all side branches of the vein graft are double-clipped. Vascular histology is analyzed in a randomized selection of vein samples. After applying this standardized EVH protocol, the learning curve was shown to be steep, and graft quality was sufficient for coronary artery bypass grafting in every case. There was no conversion to surgical harvesting and low risks for tissue damage and bleeding. Leg positioning and synergizing EVH with bridging vein harvesting improved procedural success and vein graft quality. In our hands, antegrade EVH from the lower leg was feasible, demonstrating straightforward graft dissection as well as adequate macroscopic and microscopic graft quality with preserved endothelial integrity. In conclusion, the introduced technique is safe, shows excellent vein autograft quality, and illustrates feasibility for elective and urgent isolated CABG and combined CABG scenarios.

Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights from the REGROUP Trial

To assess the use of epiaortic ultrasound in contemporary cardiac surgery, as well as its impact on surgical cannulation strategy and cerebrovascular events. Epiaortic ultrasound data was prospectively collected in the Randomized Endovein Graft Prospective (REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov, NCT01850082), which randomized 1,150 coronary artery bypass graft patients between 2014 and 2017 to endoscopic or open-vein graft harvest. Sixteen cardiac surgery programs within the Veterans Affairs Healthcare System with expertise at performing endoscopic vein-graft harvesting. Veterans Affairs patients, greater than 18 years of age, undergoing elective or urgent coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest with at least one planned saphenous vein graft were eligible for enrollment. Epiaortic ultrasound was performed by the surgeon using a high frequency (>7 MHz) ultrasound transducer. Two-dimensional images of the ascending aorta in multiple planes were acquired before aortic cannulation and cross-clamping. Epiaortic ultrasound was performed in 34.1% (269 of 790) of patients in REGROUP. Among these patients, simple intraluminal atheroma was observed in 21.9% (59 269), and complex intraluminal atheroma comprised 2.2% (6 of 269). The aortic cannulation or cross-clamp strategy was modified based on these findings in 7.1% of cases (19 of 269). There was no difference in stroke between patients who underwent epiaortic ultrasound and those who did not (1.9% v 1.2% p = 0.523). Despite current guidelines recommending routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac surgery, in this contemporary trial, use remains infrequent, with significant site-to-site variability.

What will surgical coronary revascularization look like in 25 years?

Coronary artery bypass grafting evolved in incremental but significant steps since its introduction. Here, we provide an update on operative techniques, choice of conduits, patient selection/decision-making and primary and secondary prevention measures with potential of influencing the future of coronary artery bypass grafting (CABG) surgery. Associated mortality of off-pump CABG (OPCAB) procedures performed in high-volume OPCAB centers (≥164 cases per year) and by experienced surgeons (≥48 cases per year) was reduced compared with on-pump CABG with two or more grafts suggesting a volume-based dependency of outcomes in CABG procedures with high-technical complexity. Ten-year results from the recent Arterial Revascularization Trial showed no significant between-group difference for the primary and secondary outcome. Total arterial revascularization using composite bilateral internal mammary artery-Y-conduits through a limited access mini-thoracotomy was not only shown to be feasible but a safe and reproducible procedure with excellent midterm outcomes. The most recent Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass (REGROUP) trial demonstrated no significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the occurrence of major adverse cardiac events. Adherence to the most recent guidelines on myocardial revascularization is a key component for providing state-of the CABG surgery. Trends to lesser invasiveness in surgical coronary revascularization will gain momentum and is expected - with further improvements - to be the mainstay of future surgical coronary revascularization strategies.

Endoscopic Harvesting in Coronary Artery Bypass Grafting.

Endoscopic Harvesting in Coronary Artery Bypass Grafting.

A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry

BackgroundVein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures.MethodsThis ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected.The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft.DiscussionThis European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level).Trial registrationClinicalTrials.gov NCT02922088. Registered October 3, 2016.Ethics and disseminationThe regional ethics committees have approved the registry. Results will be submitted for publication.

Use of endoscopic vein harvesting (EVH) during coronary artery bypass grafting in United Kingdom: The EVH survey.

Endoscopic vein harvesting (EVH) is growing in popularity and is the method of choice in many centers worldwide as it is associated with lower complication rates compared to the open vein harvesting. The aim of this study was to determine the current use of EVH during coronary artery bypass grafting among cardiac surgeons in United Kingdom and identify the main concerns that limit the use of this technique. We developed an online survey with 16 questions about the use of EVH. An invitation to participate was sent to all the adult cardiac surgeons currently in practice in United Kingdom. A total of 139 surgeons (52%) of 267 currently in practice across 48 different hospitals completed the survey. Twenty five percent of responding surgeons always use EVH while 44% use it for <10% cases. Forty eight percent of responders regard EVH as an expensive technique and 90% believe that EVH is associated with fewer leg wound issues. Seventy five percent of responding surgeons will use it for their patients due to no leg wound issues while 25% believe that the concerns about patency of EVH are genuine. The majority of UK cardiac surgeons responding to this survey will preferentially consider EVH for obese and diabetic patients and are convinced by its beneficial impact in reducing leg wound complications. However, the reported routine use of EVH is low. Concerns about cost and patency of the endoscopically harvested vein are the possible barriers for universal adoption of EVH in the United Kingdom.

Robotic-assisted Latissimus Dorsi Muscle Flap for Autologous Breast Reconstruction

BACKGROUND: Latissimus dorsi (LD) muscle flap has been widely used for autologous breast reconstruction.1 Traditional open LD flap harvest requires a posterior donor site incision with a length of 15–45 cm. Although the scar can be camouflaged for women when wearing the bra, it tends to be long, frequently widens, and hypertrophies with time.2 Therefore, a minimally invasive technique to harvest LD muscle flap via endoscopic approach has been developed. Despite continuous improvements in surgical techniques and technologies, 2-dimensional view and nonflexible instruments are limitations of endoscopic harvest of the LD muscle flap.3 Meanwhile, a robotic-assisted LD muscle flap has been first introduced for autologous breast reconstruction after mastectomy.4 The authors has demonstrated a modified robotic surgical technique using a transaxillary gasless technique for robot-assisted LD muscle flaps in 2012.5 The purpose of this study was to introduce our 7-year experience with the robotic-assisted LD muscle flaps in autologous breast reconstruction. PATIENTS AND METHODS: Between October 2012 and February 2019, a total of 33 patients underwent autologous breast reconstructions using robotic-assisted LD muscle flap. Among 33 patients, 21 patients had Poland syndrome. Seven and 3 patients underwent robotic-assisted LD flap following immediate and delayed breast reconstruction after mastectomy, respectively. Two patients had capsular contracture of implant. Subjective assessment was performed to evaluate satisfaction of overall outcome, breast symmetry, and scar. Mean follow-up time was 29.8 ± 12.5 months (range, 3–61 months). RESULTS: All 33 flaps were successfully transferred without converting to open technique. As our experience with robotic-assisted LD flap increased steadily over the years, we have achieved improvements in surgical techniques and robotic instruments to comfort during surgery, optimize the results, and minimize complications and contour defects compared to the first time with robotic surgery. In addition, the time for robotic surgery system also markedly decreased after experience accumulation. Recently, the time for robotic docking and robotic surgery was about 30 and 60 minutes, respectively. At the last visit, patients’ average grading of satisfaction of overall outcome, breast symmetry, and scar were 4.75 ± 0.23, 4.32 ± 0.63, and 4.88 ± 0.15, respectively. No serious complications such as flap loss were recorded for any patient. CONCLUSION: Autologous breast reconstruction using robotic-assisted LD muscle flap might be effective and safe. REFERENCES: 1. Arslan E, Unal S, Demirkan F, et al. Poland’s syndrome with rare deformities: reconstruction with latissimus dorsi muscle through a single short incision. Scand J Plast Reconstr Surg Hand Surg. 2003;37:304–306. 2. Moore TS, Farrell LD. Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg. 1992;89:666–672; discussion 673–664. 3. Pomel C, Missana MC, Atallah D, et al. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol. 2003;29:127–131. 4. Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg. 2012;129:1305–1312. 5. Chung JH, You HJ, Kim HS, et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg. 2015;68:966–972.

MORPHO-FUNCTIONAL CONDITION OF VENOUS CONDUITS AFTER ENDOSCOPIC HARVESTING

Background. The morpho-functional integrity of the structures of the wall of the venous conduit during coronary artery bypass grafting is the guarantor of the functioning of autovenous bypass grafts in the long-term period. Allocating a vein in a flap with surrounding tissues ensures minimal effect on the vein with better results in the long-term, but it increases the risk of wound complications. Endoscopic vein harvesting contributes to a significant reduction in wound complications. However, according to literary data, this technique can negatively affect the bypass grafts passability due to the effects of mechanical manipulations and exposure to carbon dioxide. Previously, we developed a method for the endoscopic vein extraction in a flap with surrounding tissues that does not require carbon dioxide insufflation.Aim. The aim of the study was to assess the morphological and functional changes in the vein fragments harvested by the new original endoscopic method compared to the traditional open harvesting technique.Material and Methods. The fragments of the great saphenous vein were studied after endoscopic and open harvesting. From the access in the knee area, a 3–5 cm fragment of the vein was openly harvested and was then used for the biopsy in the control group. Next, the vein was harvested endoscopically and the fragments of this part of the vein comprised the study group. Light microscopy of the sections, stained with hematoxylin and eosin, was performed to assess the structural integrity of the venous walls; the expression of CD 31 and E-Cadherin was determined immunohistochemically to assess the viability and function of the endothelium.Results. The results of histological study suggested that the endothelium was more intact in the segments harvested endoscopically; moreover, immunohistochemistry data showed that the endothelium was more viable in these segments.

On-Pump Coronary Artery Bypass Graft: The State of the Art.

Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off- pump surgery. Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG. Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients. CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.

Endoscopic radial artery harvesting with a non-sealed approach.

Endoscopic radial artery harvesting is considered a safe and effective approach for graft procurement during coronary artery bypass graft surgery. As an alternative to open techniques, minimally invasive approaches are associated with superior outcomes in terms of morbidity and patients' discomfort, without affecting graft quality, patency rate, and long-term outcomes. Both sealed and non-sealed systems are available for endoscopic conduit harvesting. Sealed systems require carbon dioxide gas insufflation, which may have a damaging impact on the endothelium. Non-sealed systems do not require carbon dioxide insufflation and thus avoid the potential drawbacks of its use. In this video tutorial, we provide a thorough description of the surgical technique for endoscopic radial artery harvesting using a non-sealed approach.

Endoscopic saphenous vein harvesting with a non-sealed approach.

Endoscopic saphenous vein harvesting is considered a safe and effective approach for graft procurement during coronary artery bypass graft surgery. As an alternative to open techniques, minimally invasive approaches are associated with superior outcomes in terms of morbidity and patients' discomfort, without affecting graft quality, patency rate, and long-term outcomes. Both sealed and non-sealed systems are available for endoscopic conduit harvesting. Sealed systems require carbon dioxide gas insufflation, which may have a damaging impact on the endothelium. Non-sealed systems do not require carbon dioxide insufflation and thus avoid the potential drawbacks of its use. In this video tutorial, we provide a thorough description of the surgical technique for endoscopic saphenous vein harvesting using a non-sealed approach.

400.12 Morphological Changes in Saphenous Veins Harvested with Conventional and Endoscopic Technique in Coronary-Artery Bypass Surgery

Coronary-artery bypass grafting (CABG) still represents the most successful treatment of coronary artery disease. The patency of the graft could depend on surgical technique (endoscopic or conventional harvesting) which could cause damage of saphenous vein (SV). The aim of our study was to elucidate

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

BackgroundThe saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized.MethodsWe randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated.ResultsA total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarctions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15).ConclusionsAmong patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082.)

Endoscopic Radial Artery Harvest in Coronary Artery Bypass Surgery: Clinicopathological Evaluation

Objectives: The radial artery is used as a second arterial conduit in coronary artery bypass surgery. However, concerns exist about the thermal injury incurred to the radial artery during endoscopic harvest. We sought to assess this effect both histologically and radiologically. Methods: From February 2015 to March 2016, 50 consecutive patients undergoing coronary artery bypass surgery utilizing endoscopically harvested radial artery were prospectively studied. Computerized tomography coronary angiography scan was performed randomly in 8 patients who also had their respective radial artery analyzed histologically at the time of harvest. Standard coronary angiography was also performed in 4 additional patients driven by symptoms recurrence. Results: All patients were available for follow up at 1 year following the surgery. There was no mortality during follow-up. Three patients (6%) developed transient complications in the harvest arm which resolved. All radial arteries were patent on follow-up imaging. Histological examination showed integrity of the arterial wall, intact endothelial lining, patent lumens and no significant pathological abnormalities. Conclusion: The use of endoscopic radial artery harvest was associated with few self-limiting morbidities and excellent patency rates. In addition, there was no evidence of any thermal or traumatic injuries sustained to the radial arteries when examined histologically. The use of endoscopically harvested radial arteries appears safe with excellent results.