Document Detail


Is endoscopic harvesting bad for saphenous vein graft patency in coronary surgery?
MedLine Citation:
PMID:  21986399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Endoscopic vein harvest (EVH) has quickly been adopted as the standard-of-care for coronary artery bypass grafting (CABG). Despite clear advantages in terms of wound morbidity, healing, pain, and patient satisfaction, data from recent large clinical trials have called the safety of this technique into question.
RECENT FINDINGS: Post-hoc analyses of a variety of prospective trials have suggested EVH is associated with decreased graft patency, higher rates of cardiovascular complications (e.g. myocardial infarction, need for repeat revascularization) and mortality. Imaging studies of veins procured by EVH have revealed retained clot and vascular injury, particularly during the 'learning curve' of the technician. These findings may alter the quality of the conduit and, therefore, the outcome of the bypass graft. Elucidating the mechanisms that underlie any differences in results produced by the open and endoscopic procedures would help better inform clinical practice and the development of targeted strategies to improve EVH.
SUMMARY: Clear clinical advantages over traditional open vein harvest have allowed EVH to rapidly become the standard-of-care for harvesting of one or more vein grafts during CABG. The quality of these conduits, suggested to be equivalent by early studies, has come into question as groups with varying levels of experience have adopted the endoscopic technique. Elucidating the principles of 'best practice' for vein harvest will likely help shorten the learning curve and improve the safety of EVH.
Authors:
Soroosh Kiani; Robert Poston
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  26     ISSN:  1531-7080     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-12     Completed Date:  2012-02-03     Revised Date:  2014-10-22    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  518-22     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures
Coronary Artery Bypass / methods*
Coronary Artery Disease / surgery*
Endoscopy
Graft Survival
Humans
Postoperative Complications
Saphenous Vein / transplantation*
Time Factors
Tissue and Organ Harvesting
Treatment Outcome
Vascular Patency*
Grant Support
ID/Acronym/Agency:
R01 HL084080/HL/NHLBI NIH HHS; R01 HL084080/HL/NHLBI NIH HHS
Comments/Corrections

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


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