Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Ann Thorac Surg. 2010 Feb;89(2):403-8. doi: 10.1016/j.athoracsur.2009.09.061.
Endoscopic saphenous vein harvest (EVH) decreases leg wound infections and improves cosmesis after coronary artery bypass grafting (CABG). Recent data, however, suggest that EVH may be associated with reduced graft patency rates. The objective of this study is to assess the effect of EVH on short-term and midterm outcomes after CABG.
Data were prospectively collected on all first-time isolated CABG and combined valve/CABG with saphenous vein graft between 1998 and 2007 at a single center. Patients having traditional "open" vein harvest (OVH) were compared with patients having EVH. Multivariate models were used to examine the risk-adjusted impact of EVH on postoperative leg infection, composite in-hospital adverse events, and individual and composite midterm adverse events.
The study included 5,825 patients, of whom 2,004 (34.4%) had EVH. Patients having EVH were more likely to have ejection fraction less than 50% (32.0% versus 29.3%, p = 0.04), recent myocardial infarction (24.2% versus 18.3%, p < 0.0001), and left main disease (26.0% versus 22.1%, p = 0.0009). Median follow-up was 2.6 years. After risk adjustment, EVH was associated with reduced rates of leg infection (odds ratio 0.48, p = 0.003) but had no association with either in-hospital (odds ratio 0.93, p = 0.56) or midterm adverse outcomes (hazard ratio 0.93, p = 0.22). Endoscopic saphenous vein harvest was associated with reduced readmission to hospital for unstable angina (odds ratio 0.74, p = 0.01).
Endoscopic saphenous vein harvest is associated with a lower rate of leg infection and is not an independent predictor of in-hospital or midterm adverse outcomes. Endoscopic saphenous vein harvest is a safe alternative to OVH for patients undergoing CABG with saphenous vein.
内镜下隐静脉采集（EVH）可降低冠状动脉旁路移植术（CABG）后腿部伤口感染率，改善美容效果。然而，最近的数据表明，EVH 可能与移植通畅率降低有关。本研究旨在评估 EVH 对 CABG 术后短期和中期结局的影响。
在一个中心，前瞻性收集了 1998 年至 2007 年间首次接受单纯 CABG 和合并瓣膜/CABG 并使用隐静脉移植物的所有患者的数据。将接受传统“开放式”静脉采集（OVH）的患者与接受 EVH 的患者进行比较。使用多变量模型来检查 EVH 对术后腿部感染、住院期间复合不良事件以及个体和复合中期不良事件的风险调整影响。
该研究共纳入 5825 例患者，其中 2004 例（34.4%）接受 EVH。接受 EVH 的患者射血分数<50%（32.0%比 29.3%，p=0.04）、近期心肌梗死（24.2%比 18.3%，p<0.0001）和左主干疾病（26.0%比 22.1%，p=0.0009）的发生率更高。中位随访时间为 2.6 年。经过风险调整后，EVH 与腿部感染发生率降低相关（比值比 0.48，p=0.003），但与住院期间（比值比 0.93，p=0.56）或中期不良结局（风险比 0.93，p=0.22）均无相关性。内镜下隐静脉采集与因不稳定型心绞痛再入院率降低相关（比值比 0.74，p=0.01）。
内镜下隐静脉采集与较低的腿部感染发生率相关，且不是住院期间或中期不良结局的独立预测因素。对于接受 CABG 并使用隐静脉的患者，内镜下隐静脉采集是 OVH 的安全替代方法。
