A randomized study comparing three groups of vein harvesting methods for coronary artery bypass grafting: endoscopic harvest versus standard bridging and open techniques

作者：Krishnamoorthy Bhuvaneswari; Critchley William R; Glover Alex T; Nair Janesh; Jones Mark T; Waterworth Paul D; Fildes James E; Yonan Nizar^*

来源：Interactive Cardiovascular and Thoracic Surgery, 2012, 15(2): 224-228.

DOI：10.1093/icvts/ivs164

• Coronary artery bypass
• Saphenous vein
• Minimally invasive
• Tissue and organ harvesting/adverse effects
• Tissue and organ harvesting/methods
• Wound healing

OBJECTIVES: The use of an open vein harvesting (OVH) technique for saphenous vein harvesting (SVH) is associated with wound complications and delayed patient mobilization. This has led to the development of minimally invasive vein harvesting (MIVH) techniques, such as standard bridging and endoscopic SVH (EVH). This randomized trial was established to assess immediate clinical outcome and patient satisfaction in our centre.
METHODS: A total of 150 consecutive patients were prospectively randomized into three groups. Group 1 consisted of 50 patients who underwent OVH, Group 2 consisted of 50 patients who underwent a standard bridging technique (SBT) and Group 3 consisted of 50 patients who underwent EVH. Each group was assessed for the incidence of wound infection, postoperative pain and satisfaction and the number of vein repairs using previously validated scoring systems.
RESULTS: The MIVH techniques reduced the pain at hospital (P < 0.001) and at 6 weeks (P < 0.001), and improved cosmesis (P < 0.001), compared with the OVH group. Patient satisfaction was greatest in the EVH group followed by the SBT and then the OVH group. The clinical markers of inflammation were reduced with an MIVHt. There were more vein repairs in the EVH compared with the OVH (P < 0.001) and the SBT (P = 0.04) groups.
CONCLUSIONS: This study demonstrates that MIVH reduces wound morbidity. We believe that each technique has advantages and disadvantages, which should be considered during the selection of a harvesting procedure by both the patient and the surgeon.

• 出版日期2012-8