The Transition from Open to Endoscopic Saphenous Vein Harvesting and Its Clinical Impact
Identifieur interne : 001245 ( Pmc/Curation ); précédent : 001244; suivant : 001246The Transition from Open to Endoscopic Saphenous Vein Harvesting and Its Clinical Impact
Auteurs : Tianjie Lai ; Yarrow Babb ; Qian Ning ; Luz Reyes ; Thanh Dao ; Vei-Vei Lee ; Laurie Mitchell ; Layne O. Gentry ; Ross M. Reul ; David A. OttSource :
- Texas Heart Institute Journal [ 0730-2347 ] ; 2006.
Abstract
Open saphenous vein harvesting can be associated with wound complications, incision pain, prolonged convalescence, and poor cosmetic results. Endoscopic vein harvesting has been widely used for prevention of these problems. We compared outcomes of open and endoscopic vein harvesting for coronary artery bypass grafting at the Texas Heart Institute.
We retrospectively analyzed data from 1,573 consecutive coronary artery bypass procedures performed at our institution during a 20-month period. Each procedure included saphenectomy by endoscopic vein harvesting (n=588) performed by physician assistants, or by traditional open vein harvesting (n=985) performed by physicians or physician assistants. The primary outcome variable was the incidence of postoperative leg infections.
Both groups were similar in terms of preoperative risk factors. After surgery, leg wound infections were significantly less frequent in the endoscopic vein harvesting group (3/588, 0.5%) than in the open vein harvesting group (27/985, 2.7%;
We conclude that endoscopic vein harvesting reduces leg wound infections, is safe and reliable, and should be the standard of care when venous conduits are required for coronary artery bypass grafting and vascular procedures. Although the transition from open to endoscopic vein harvesting can be challenging in institutions, it can be successful if operators receive adequate training in endoscopic technique and are supported by surgeons and staff.
Url:
PubMed: 17041688
PubMed Central: 1592263
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<author><name sortKey="Lai, Tianjie" sort="Lai, Tianjie" uniqKey="Lai T" first="Tianjie" last="Lai">Tianjie Lai</name>
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<author><name sortKey="Babb, Yarrow" sort="Babb, Yarrow" uniqKey="Babb Y" first="Yarrow" last="Babb">Yarrow Babb</name>
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<author><name sortKey="Ning, Qian" sort="Ning, Qian" uniqKey="Ning Q" first="Qian" last="Ning">Qian Ning</name>
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<author><name sortKey="Reyes, Luz" sort="Reyes, Luz" uniqKey="Reyes L" first="Luz" last="Reyes">Luz Reyes</name>
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<author><name sortKey="Dao, Thanh" sort="Dao, Thanh" uniqKey="Dao T" first="Thanh" last="Dao">Thanh Dao</name>
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<author><name sortKey="Lee, Vei Vei" sort="Lee, Vei Vei" uniqKey="Lee V" first="Vei-Vei" last="Lee">Vei-Vei Lee</name>
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<author><name sortKey="Mitchell, Laurie" sort="Mitchell, Laurie" uniqKey="Mitchell L" first="Laurie" last="Mitchell">Laurie Mitchell</name>
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<author><name sortKey="Gentry, Layne O" sort="Gentry, Layne O" uniqKey="Gentry L" first="Layne O." last="Gentry">Layne O. Gentry</name>
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<author><name sortKey="Reul, Ross M" sort="Reul, Ross M" uniqKey="Reul R" first="Ross M." last="Reul">Ross M. Reul</name>
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<author><name sortKey="Dao, Thanh" sort="Dao, Thanh" uniqKey="Dao T" first="Thanh" last="Dao">Thanh Dao</name>
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<author><name sortKey="Lee, Vei Vei" sort="Lee, Vei Vei" uniqKey="Lee V" first="Vei-Vei" last="Lee">Vei-Vei Lee</name>
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<series><title level="j">Texas Heart Institute Journal</title>
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<front><div type="abstract" xml:lang="en"><p>Open saphenous vein harvesting can be associated with wound complications, incision pain, prolonged convalescence, and poor cosmetic results. Endoscopic vein harvesting has been widely used for prevention of these problems. We compared outcomes of open and endoscopic vein harvesting for coronary artery bypass grafting at the Texas Heart Institute.</p>
<p>We retrospectively analyzed data from 1,573 consecutive coronary artery bypass procedures performed at our institution during a 20-month period. Each procedure included saphenectomy by endoscopic vein harvesting (n=588) performed by physician assistants, or by traditional open vein harvesting (n=985) performed by physicians or physician assistants. The primary outcome variable was the incidence of postoperative leg infections.</p>
<p>Both groups were similar in terms of preoperative risk factors. After surgery, leg wound infections were significantly less frequent in the endoscopic vein harvesting group (3/588, 0.5%) than in the open vein harvesting group (27/985, 2.7%; <italic>P</italic>
<0.002). The most common organism involved in leg infections was <italic>Staphylococcus</italic>
(20/30, 66%): <italic>S. aureus</italic>
was present in 14 of 30 infections (47%). Open vein harvesting was the only significant independent risk factor for leg infection.</p>
<p>We conclude that endoscopic vein harvesting reduces leg wound infections, is safe and reliable, and should be the standard of care when venous conduits are required for coronary artery bypass grafting and vascular procedures. Although the transition from open to endoscopic vein harvesting can be challenging in institutions, it can be successful if operators receive adequate training in endoscopic technique and are supported by surgeons and staff.</p>
</div>
</front>
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<pmc article-type="other"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Tex Heart Inst J</journal-id>
<journal-id journal-id-type="publisher-id">Texas Heart Institute Journal</journal-id>
<journal-title>Texas Heart Institute Journal</journal-title>
<issn pub-type="ppub">0730-2347</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">17041688</article-id>
<article-id pub-id-type="pmc">1592263</article-id>
<article-id pub-id-type="publisher-id">0010801-200609000-00008</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Investigation</subject>
</subj-group>
</article-categories>
<title-group><article-title>The Transition from Open to Endoscopic Saphenous Vein Harvesting and Its Clinical Impact</article-title>
<subtitle>The Texas Heart Institute Experience</subtitle>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lai</surname>
<given-names>Tianjie</given-names>
</name>
<degrees>PA-C, MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Babb</surname>
<given-names>Yarrow</given-names>
</name>
<degrees>PA-C</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Ning</surname>
<given-names>Qian</given-names>
</name>
<degrees>PA-C</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Reyes</surname>
<given-names>Luz</given-names>
</name>
<degrees>RNFA</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Dao</surname>
<given-names>Thanh</given-names>
</name>
<degrees>ASCP</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>Vei-Vei</given-names>
</name>
<degrees>MS</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Mitchell</surname>
<given-names>Laurie</given-names>
</name>
<degrees>RN, EdD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Gentry</surname>
<given-names>Layne O.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Reul</surname>
<given-names>Ross M.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author"><name><surname>Ott</surname>
<given-names>David A.</given-names>
</name>
<degrees>MD</degrees>
</contrib>
</contrib-group>
<aff>Division of Cardiovascular Surgery, the Texas Heart Institute at St. Luke's Episcopal Hospital (Drs. Lai, Mitchell, Ott, and Reul; Mr. Babb, Ms Lee, Ms Ning, and Ms Reyes) and Department of Infection Control (Dr. Gentry and Ms Dao), St. Luke's Episcopal Hospital, Houston, Texas 77030<break></break>
</aff>
<pub-date pub-type="ppub"><year>2006</year>
</pub-date>
<volume>33</volume>
<issue>3</issue>
<fpage>316</fpage>
<lpage>320</lpage>
<copyright-statement>© 2006 by the Texas Heart® Institute, Houston</copyright-statement>
<abstract><p>Open saphenous vein harvesting can be associated with wound complications, incision pain, prolonged convalescence, and poor cosmetic results. Endoscopic vein harvesting has been widely used for prevention of these problems. We compared outcomes of open and endoscopic vein harvesting for coronary artery bypass grafting at the Texas Heart Institute.</p>
<p>We retrospectively analyzed data from 1,573 consecutive coronary artery bypass procedures performed at our institution during a 20-month period. Each procedure included saphenectomy by endoscopic vein harvesting (n=588) performed by physician assistants, or by traditional open vein harvesting (n=985) performed by physicians or physician assistants. The primary outcome variable was the incidence of postoperative leg infections.</p>
<p>Both groups were similar in terms of preoperative risk factors. After surgery, leg wound infections were significantly less frequent in the endoscopic vein harvesting group (3/588, 0.5%) than in the open vein harvesting group (27/985, 2.7%; <italic>P</italic>
<0.002). The most common organism involved in leg infections was <italic>Staphylococcus</italic>
(20/30, 66%): <italic>S. aureus</italic>
was present in 14 of 30 infections (47%). Open vein harvesting was the only significant independent risk factor for leg infection.</p>
<p>We conclude that endoscopic vein harvesting reduces leg wound infections, is safe and reliable, and should be the standard of care when venous conduits are required for coronary artery bypass grafting and vascular procedures. Although the transition from open to endoscopic vein harvesting can be challenging in institutions, it can be successful if operators receive adequate training in endoscopic technique and are supported by surgeons and staff.</p>
</abstract>
<kwd-group><title>Key words</title>
<kwd>Coronary artery bypass</kwd>
<kwd>endoscopic vein harvesting</kwd>
<kwd>saphenous vein/surgery</kwd>
<kwd>surgical wound infection</kwd>
<kwd>vascular surgical procedures/methods</kwd>
</kwd-group>
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