This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standar...This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=72) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P〉0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P〉0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06, P〉0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, P〉0.05), vessel dysfunction rate (11.25% vs. 11.11%, P〉0.05) and mortality (0.00% vs. 0.00%, P〉0.05). Use of EVH was associated with significant reduction of total harvesting time (41±6 min vs. 63±11 min, P〈0.05), incision length (4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05) and postoperative lower extremity complications (P〈0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.展开更多
Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein ha...Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.展开更多
Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them...Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them 106 cases had both single(159) and sequential(118) grafts.Results:The oc-clusive and narrowness rate for the single grafts versus sequential grafts were:1 year,2% vs 2%;5 years,3% vs 4%;10years,18% vs 19%;15 years,60% vs 68%;and 23 years,76% vs 81% ,respectively.The differences were not significant in general.Conclusion:Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.展开更多
Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are es...Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.展开更多
Objective: To explore the alleviation of arterial intimal hyperplasia and improvement of outflow by inserting an autogenous vein cuff between poly tetraflu oroethylene (PTFE) graft and arteri al an astomosis. Methods:...Objective: To explore the alleviation of arterial intimal hyperplasia and improvement of outflow by inserting an autogenous vein cuff between poly tetraflu oroethylene (PTFE) graft and arteri al an astomosis. Methods: Twenty-four hindlimbs of 12 mongrel dogs were randomly divided into control group and experimental group. Sole PTFE bypasses were made in the control group, an autologous vein cuff was inserted in the distal anastomosis in the experimental group. Eight weeks after operation, angiography was made and specimens were harvested, histomorphological studies under microscope and picture analysis with computer were carried out, scanning electromicroscopy on the vein cuff was made. Results: Angiography demonstrated the patency of control and experimental group was 16. 7% and 66. 7%, respectively; Computer gave the intimal thickness: (483. 5 ± 67. 3) μm and (147. 4 ± 38. 6) μm, respectively; no obvious change was seen in medial thickness; area of intimal hyperplasia was (5217 ± 1 123) (pixel) and (31 17 ± 890) (pixel), respectively, accounting (80. 9 ± 17. 2)% and (47. 7 ± 13. 7)% of the sectional area of vessel lumen. The interpositional vein was arteriolization. Conclusion: The interpositional autologous vein cuff can obviously mitigate the arterial intimal hyperplasia after PTFE bypasses, improving postoperative patency of vascular surgery.展开更多
Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospe...Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospective review of all coronary artery bypass graft (CABG) procedures performed from January 1, 2000 through June 30, 2013 with and without concomitant coronary endarterectomy (CE), was carried out at the Veterans Affairs Medical Center in Washington DC. Patients who underwent concomitant valve operations were excluded. Primary outcome was overall survival, with analyses performed examining CE as well as the use of cardiopulmonary bypass. Secondary outcomes included 30-day mortality and post-operative MI. Results: 1255 CABG operations were performed, 10 of which included CE. All CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits. 1-year survival was 70%. 5-year survival was 43% out of 7 patients. Conclusions: Pull-through CE with saphenous vein patch is a safe alternative technique for patients with diffuse coronary artery disease. Perioperative events and intermediate outcomes are favorable, although long-term survival is less than patients without CE.展开更多
Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, bra...Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, branching, or varicose saphenous veins. The location of the saphenous vein was marked. Saphenous veins were harvested by the open harvest technique, and the caliber of the veins and the availability of the anastomosis device were recorded. Postoperative morbidity was recorded. Preoperative findings revealed that four (6.5%) of 62 femoral saphenous veins were estimated as “not graftable” because of being a varicose vein or having a small caliber. Seven of 32 lower saphenous veins were estimated as “not graftable”. The mean discrepancy of the caliber was 0.6 mm undersized with preoperative estimation. During harvesting, one of 31 patients had a wrong marking. We were able to use all harvested veins. The morbidity of saphenous harvesting was observed in two (6.5%) of 31 patients. One patient whose marking was wrong had minor skin necrosis. Another patient experienced a hematoma because of the excess effect of warfarin. Preoperative ultrasonic mapping of the saphenous vein reduced useless harvesting, provided information concerning anastomosis device availability, and seemed to reduce morbidity because dissection can be minimal.展开更多
文摘This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=72) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P〉0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P〉0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06, P〉0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, P〉0.05), vessel dysfunction rate (11.25% vs. 11.11%, P〉0.05) and mortality (0.00% vs. 0.00%, P〉0.05). Use of EVH was associated with significant reduction of total harvesting time (41±6 min vs. 63±11 min, P〈0.05), incision length (4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05) and postoperative lower extremity complications (P〈0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.
文摘Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.
文摘Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them 106 cases had both single(159) and sequential(118) grafts.Results:The oc-clusive and narrowness rate for the single grafts versus sequential grafts were:1 year,2% vs 2%;5 years,3% vs 4%;10years,18% vs 19%;15 years,60% vs 68%;and 23 years,76% vs 81% ,respectively.The differences were not significant in general.Conclusion:Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.
文摘Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.
文摘Objective: To explore the alleviation of arterial intimal hyperplasia and improvement of outflow by inserting an autogenous vein cuff between poly tetraflu oroethylene (PTFE) graft and arteri al an astomosis. Methods: Twenty-four hindlimbs of 12 mongrel dogs were randomly divided into control group and experimental group. Sole PTFE bypasses were made in the control group, an autologous vein cuff was inserted in the distal anastomosis in the experimental group. Eight weeks after operation, angiography was made and specimens were harvested, histomorphological studies under microscope and picture analysis with computer were carried out, scanning electromicroscopy on the vein cuff was made. Results: Angiography demonstrated the patency of control and experimental group was 16. 7% and 66. 7%, respectively; Computer gave the intimal thickness: (483. 5 ± 67. 3) μm and (147. 4 ± 38. 6) μm, respectively; no obvious change was seen in medial thickness; area of intimal hyperplasia was (5217 ± 1 123) (pixel) and (31 17 ± 890) (pixel), respectively, accounting (80. 9 ± 17. 2)% and (47. 7 ± 13. 7)% of the sectional area of vessel lumen. The interpositional vein was arteriolization. Conclusion: The interpositional autologous vein cuff can obviously mitigate the arterial intimal hyperplasia after PTFE bypasses, improving postoperative patency of vascular surgery.
文摘Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospective review of all coronary artery bypass graft (CABG) procedures performed from January 1, 2000 through June 30, 2013 with and without concomitant coronary endarterectomy (CE), was carried out at the Veterans Affairs Medical Center in Washington DC. Patients who underwent concomitant valve operations were excluded. Primary outcome was overall survival, with analyses performed examining CE as well as the use of cardiopulmonary bypass. Secondary outcomes included 30-day mortality and post-operative MI. Results: 1255 CABG operations were performed, 10 of which included CE. All CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits. 1-year survival was 70%. 5-year survival was 43% out of 7 patients. Conclusions: Pull-through CE with saphenous vein patch is a safe alternative technique for patients with diffuse coronary artery disease. Perioperative events and intermediate outcomes are favorable, although long-term survival is less than patients without CE.
文摘Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, branching, or varicose saphenous veins. The location of the saphenous vein was marked. Saphenous veins were harvested by the open harvest technique, and the caliber of the veins and the availability of the anastomosis device were recorded. Postoperative morbidity was recorded. Preoperative findings revealed that four (6.5%) of 62 femoral saphenous veins were estimated as “not graftable” because of being a varicose vein or having a small caliber. Seven of 32 lower saphenous veins were estimated as “not graftable”. The mean discrepancy of the caliber was 0.6 mm undersized with preoperative estimation. During harvesting, one of 31 patients had a wrong marking. We were able to use all harvested veins. The morbidity of saphenous harvesting was observed in two (6.5%) of 31 patients. One patient whose marking was wrong had minor skin necrosis. Another patient experienced a hematoma because of the excess effect of warfarin. Preoperative ultrasonic mapping of the saphenous vein reduced useless harvesting, provided information concerning anastomosis device availability, and seemed to reduce morbidity because dissection can be minimal.