Document Detail


Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting.
MedLine Citation:
PMID:  20103309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Endoscopic saphenous vein harvest (EVH) decreases leg wound infections and improves cosmesis after coronary artery bypass grafting (CABG). Recent data, however, suggest that EVH may be associated with reduced graft patency rates. The objective of this study is to assess the effect of EVH on short-term and midterm outcomes after CABG. METHODS: Data were prospectively collected on all first-time isolated CABG and combined valve/CABG with saphenous vein graft between 1998 and 2007 at a single center. Patients having traditional "open" vein harvest (OVH) were compared with patients having EVH. Multivariate models were used to examine the risk-adjusted impact of EVH on postoperative leg infection, composite in-hospital adverse events, and individual and composite midterm adverse events. RESULTS: The study included 5,825 patients, of whom 2,004 (34.4%) had EVH. Patients having EVH were more likely to have ejection fraction less than 50% (32.0% versus 29.3%, p = 0.04), recent myocardial infarction (24.2% versus 18.3%, p < 0.0001), and left main disease (26.0% versus 22.1%, p = 0.0009). Median follow-up was 2.6 years. After risk adjustment, EVH was associated with reduced rates of leg infection (odds ratio 0.48, p = 0.003) but had no association with either in-hospital (odds ratio 0.93, p = 0.56) or midterm adverse outcomes (hazard ratio 0.93, p = 0.22). Endoscopic saphenous vein harvest was associated with reduced readmission to hospital for unstable angina (odds ratio 0.74, p = 0.01). CONCLUSIONS: Endoscopic saphenous vein harvest is associated with a lower rate of leg infection and is not an independent predictor of in-hospital or midterm adverse outcomes. Endoscopic saphenous vein harvest is a safe alternative to OVH for patients undergoing CABG with saphenous vein.
Authors:
Maral Ouzounian; Ansar Hassan; Karen J Buth; Celeste MacPherson; Idris M Ali; Gregory M Hirsch; Imtiaz S Ali
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-17     Revised Date:  2010-10-28    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  403-8     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Unstable / etiology,  prevention & control
Combined Modality Therapy
Coronary Artery Bypass / methods*
Coronary Artery Disease / surgery*
Endoscopy / methods*
Female
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Myocardial Infarction / surgery*
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient Readmission
Postoperative Complications / etiology*,  prevention & control
Retrospective Studies
Surgical Wound Infection / etiology,  prevention & control
Tissue and Organ Harvesting / methods*
Veins / transplantation*
Comments/Corrections
Comment In:
Ann Thorac Surg. 2010 Feb;89(2):408-9   [PMID:  20103310 ]
Ann Thorac Surg. 2010 Sep;90(3):1059; author reply 1059-60   [PMID:  20732556 ]
Ann Thorac Surg. 2010 Nov;90(5):1743-4; author reply 1744   [PMID:  20971315 ]
Ann Thorac Surg. 2010 Nov;90(5):1743; author reply 1743   [PMID:  20971316 ]

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