Øystein Pettersen1, Per Magnus Haram2, Anders Winnerkvist2, Asbjørn Karevold2, Alexander Wahba3, Maryann Stenvik2, Rune Wiseth4, Knut Hegbom5, Dag Ole Nordhaug3. 1. Department of Cardiothoracic Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: oystein.pettersen@stolav.no. 2. Department of Cardiothoracic Surgery, St. Olav's University Hospital, Trondheim, Norway. 3. Department of Cardiothoracic Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 4. Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway. 5. Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway.
Abstract
BACKGROUND: Less-than-optimal long-term patency of the saphenous vein is one of the main obstacles for the success of coronary artery bypass grafting (CABG). Results from the IMPROVE-CABG trial has shown that harvesting the saphenous vein with a pedicle of perivascular tissue less than 5 mm while using manual distention provides comparable occlusion rates but significantly less intimal hyperplasia at early follow-up. The impact of pedicled veins on duration of operations, leg wound infections, and postoperative bleeding is unknown. METHODS:One hundred patients undergoing first-time elective CABG were randomly assigned to conventional or pedicled vein harvesting. Perioperative and postoperative data were collected prospectively during the hospital stay and at follow-up. RESULTS:Duration of extracorporeal circulation was significantly longer in the pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no significant difference was found in the cross-clamp time. No significant difference was found in intraoperative vein graft flow, postoperative bleeding, or leg wound infections (4% in each group). No reoperations were due to vein graft bleeding. CONCLUSIONS: Harvesting a pedicled vein provides comparable postoperative bleeding and leg wound infection rates in selected patients. The technique is associated with a slightly longer duration of extracorporeal circulation than harvesting conventional veins. Promising early results using the pedicled vein technique may contribute to a change in standard vein harvesting technique for CABG in selected patients.
RCT Entities:
BACKGROUND: Less-than-optimal long-term patency of the saphenous vein is one of the main obstacles for the success of coronary artery bypass grafting (CABG). Results from the IMPROVE-CABG trial has shown that harvesting the saphenous vein with a pedicle of perivascular tissue less than 5 mm while using manual distention provides comparable occlusion rates but significantly less intimal hyperplasia at early follow-up. The impact of pedicled veins on duration of operations, leg wound infections, and postoperative bleeding is unknown. METHODS: One hundred patients undergoing first-time elective CABG were randomly assigned to conventional or pedicled vein harvesting. Perioperative and postoperative data were collected prospectively during the hospital stay and at follow-up. RESULTS: Duration of extracorporeal circulation was significantly longer in the pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no significant difference was found in the cross-clamp time. No significant difference was found in intraoperative vein graft flow, postoperative bleeding, or leg wound infections (4% in each group). No reoperations were due to vein graft bleeding. CONCLUSIONS: Harvesting a pedicled vein provides comparable postoperative bleeding and leg wound infection rates in selected patients. The technique is associated with a slightly longer duration of extracorporeal circulation than harvesting conventional veins. Promising early results using the pedicled vein technique may contribute to a change in standard vein harvesting technique for CABG in selected patients.
Authors: Øystein Pettersen; Elżbieta Pociask; Krzysztof P Malinowski; Magdalena Slezak; Knut Hegbom; Rune Wiseth; Dag Ole Nordhaug Journal: Cardiol J Date: 2018-11-16 Impact factor: 2.737
Authors: Mario Gaudino; Irbaz Hameed; N Bryce Robinson; Yongle Ruan; Mohamed Rahouma; Ajita Naik; Viola Weidenmann; Michelle Demetres; Derrick Y Tam; David L Hare; Leonard N Girardi; Giuseppe Biondi-Zoccai; Stephen E Fremes Journal: J Am Heart Assoc Date: 2021-03-09 Impact factor: 5.501