Document Detail


Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.
MedLine Citation:
PMID:  21524447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience.
METHODS: During coronary artery bypass grafting, veins were harvested open (n=10) or by EVH (n=85) performed by experienced (>900 cases, >30/month) versus novice<100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography.
RESULTS: Conduits from experienced (n=55) versus novice (n=30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p=0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p=0.05).
CONCLUSIONS: High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.
Authors:
Pranjal Desai; Soroosh Kiani; Nannan Thiruvanthan; Stanislav Henkin; Dinesh Kurian; Pluen Ziu; Alex Brown; Nisarg Patel; Robert Poston
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  91     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-28     Completed Date:  2011-07-11     Revised Date:  2012-01-04    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1385-91; discussion 1391-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, University of Arizona, Tucson, AZ 85724-5071, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00481806
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MeSH Terms
Descriptor/Qualifier:
Clinical Competence*
Coronary Artery Bypass, Off-Pump / adverse effects,  methods*
Coronary Restenosis / epidemiology,  radiography
Coronary Stenosis / mortality,  radiography,  surgery
Endoscopy / methods*
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Learning Curve
Male
Reference Values
Risk Assessment
Saphenous Vein / transplantation*
Survival Rate
Tissue and Organ Harvesting / instrumentation,  methods*
Treatment Outcome
Vascular Patency / physiology
Grant Support
ID/Acronym/Agency:
R01 084080//PHS HHS
Comments/Corrections
Comment In:
Ann Thorac Surg. 2011 Dec;92(6):2304-5   [PMID:  22115259 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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