H T Tevaearai1, X M Mueller, L K von Segesser. 1. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. hendrik.tevaearai@chuv.hospvd.ch
Abstract
BACKGROUND: Preparation of the great saphenous vein for coronary artery bypass grafts is traditionally performed through one or many long cutaneous incisions. We describe the dissection of the great saphenous vein through small cutaneous incisions using the Mini Harvest System. METHODS: The device is composed of a retractor coupled to a light source. Introduced under the skin, above the anterior plane of the vein, it allows an easy preparation of the vein under direct vision. The entire vein can be dissected from the ankle to the groin through sequential cutaneous incisions along the leg. A prospective, randomized trial was performed to compare the minimally invasive vein harvest technique (group 1, n = 15) versus the standard method (group 2, n = 15). RESULTS: In addition to an internal mammary artery graft, 28 venous coronary bypass grafts were performed in group 1 (mean, 1.9 +/- 1.0) and 32 in group 2 (mean, 2.1 +/- 1.0). The mean cutaneous incision length divided by the mean length of the harvested vein was 10.8 cm/32.3 cm = 33% for group 1 and 37.6 cm/33.2 cm = 113% in group 2 (p < 0.001). Wounds were examined daily and a final assessment was performed on day 7. Better cicatrization, less hematoma and edema, and less pain were observed in group 1. CONCLUSIONS: Minimally invasive harvest of the great saphenous vein offers many advantages over the traditional harvest method. Besides the aesthetic aspect, healing is better and postoperative discomfort is reduced.
RCT Entities:
BACKGROUND: Preparation of the great saphenous vein for coronary artery bypass grafts is traditionally performed through one or many long cutaneous incisions. We describe the dissection of the great saphenous vein through small cutaneous incisions using the Mini Harvest System. METHODS: The device is composed of a retractor coupled to a light source. Introduced under the skin, above the anterior plane of the vein, it allows an easy preparation of the vein under direct vision. The entire vein can be dissected from the ankle to the groin through sequential cutaneous incisions along the leg. A prospective, randomized trial was performed to compare the minimally invasive vein harvest technique (group 1, n = 15) versus the standard method (group 2, n = 15). RESULTS: In addition to an internal mammary artery graft, 28 venous coronary bypass grafts were performed in group 1 (mean, 1.9 +/- 1.0) and 32 in group 2 (mean, 2.1 +/- 1.0). The mean cutaneous incision length divided by the mean length of the harvested vein was 10.8 cm/32.3 cm = 33% for group 1 and 37.6 cm/33.2 cm = 113% in group 2 (p < 0.001). Wounds were examined daily and a final assessment was performed on day 7. Better cicatrization, less hematoma and edema, and less pain were observed in group 1. CONCLUSIONS: Minimally invasive harvest of the great saphenous vein offers many advantages over the traditional harvest method. Besides the aesthetic aspect, healing is better and postoperative discomfort is reduced.