AI Article Synopsis
- Less-than-optimal long-term patency of the saphenous vein is a significant challenge in coronary artery bypass grafting (CABG), but the IMPROVE-CABG trial suggests that using a pedicle of tissue during harvesting may reduce intimal hyperplasia while maintaining comparable occlusion rates.
- A study involving 100 patients revealed that while harvesting using a pedicled vein took longer on average during extracorporeal circulation (76 mins versus 65 mins), it did not significantly affect bleeding, leg wound infections, or reoperations.
- The technique shows promise for improving vein graft outcomes in CABG, potentially changing standard harvesting practices for certain patients.
Article Abstract
Background: Less-than-optimal long-term patency of the saphenous vein is one of the main obstacles for the success of coronary artery bypass grafting (CABG). Results from the IMPROVE-CABG trial has shown that harvesting the saphenous vein with a pedicle of perivascular tissue less than 5 mm while using manual distention provides comparable occlusion rates but significantly less intimal hyperplasia at early follow-up. The impact of pedicled veins on duration of operations, leg wound infections, and postoperative bleeding is unknown.
Methods: One hundred patients undergoing first-time elective CABG were randomly assigned to conventional or pedicled vein harvesting. Perioperative and postoperative data were collected prospectively during the hospital stay and at follow-up.
Results: Duration of extracorporeal circulation was significantly longer in the pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no significant difference was found in the cross-clamp time. No significant difference was found in intraoperative vein graft flow, postoperative bleeding, or leg wound infections (4% in each group). No reoperations were due to vein graft bleeding.
Conclusions: Harvesting a pedicled vein provides comparable postoperative bleeding and leg wound infection rates in selected patients. The technique is associated with a slightly longer duration of extracorporeal circulation than harvesting conventional veins. Promising early results using the pedicled vein technique may contribute to a change in standard vein harvesting technique for CABG in selected patients.
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| http://dx.doi.org/10.1016/j.athoracsur.2017.03.076 | DOI Listing |
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