Kirmani Bilal H, Barnard James B, Mourad Faisal, Blakeman Nadene, Chetcuti Karen, Zacharias Joseph
Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, Lancashire, UK.
J Cardiothorac Surg. 2010 May 28;5:44. doi: 10.1186/1749-8090-5-44.
Saphenous vein remains the most common conduit for coronary artery bypass grafting with increasing uptake of minimally invasive harvesting techniques. While Endoscopic Vein Harvest (EVH) has been demonstrated to improve early morbidity compared to Open Vein Harvest (OVH), recent literature suggests that this may be at the expense of graft patency at one year and survival at three years.
We undertook a retrospective single-centre, single-surgeon, case-control study of EVH (n = 89) and OVH (n = 182). The primary endpoint was death with secondary endpoints including acute coronary syndrome, revascularisation or other major adverse cardiac events. Freedom from angina, wound complications and self-rated health status were also assessed. Where repeat angiography had been performed, this was reviewed.
Both groups were well matched demographically and for peri-operative characteristics. All cause mortality was 2/89 (2%) and 11/182 (6%) in the EVH and OVH groups respectively. This was shown by Cox Log-Rank analysis to be non-significant (p = 0.65), even if adjusting for inpatient mortality (p = 0.74). There was no difference in the rates of freedom from angina (p = 1.00), re-admission (p = 0.78) or need for further anti-anginals (p = 1.00). There was a significant reduction in the incidence of leg wound infections and complications in the endoscopic group (EVH: 7%; OVH: 28%; p = 0.0008) and the skew of high patient self-rated health scores in the EVH group (61% compared to 52% in the open group) approached statistical significance (p = 0.06).
While aware of the limitations of this small retrospective study, we are heartened by the preliminary results and consider our data to be justification for continuing to provide patients the opportunity to have minimally invasive conduit harvest in our centre. More robust evidence is still required to elucidate the implications of endoscopic techniques on conduit patency and patient outcome, but until the results of a large, prospective and randomised trial are available, we believe we can confidently offer our patients the option and benefits of EVH.
随着微创获取技术的应用增加，大隐静脉仍是冠状动脉旁路移植术最常用的血管桥。虽然与开放静脉获取（OVH）相比，内镜静脉获取（EVH）已被证明可降低早期发病率，但最近的文献表明，这可能是以牺牲一年时的血管桥通畅率和三年时的生存率为代价的。
我们进行了一项回顾性单中心、单术者的病例对照研究，纳入了89例接受EVH的患者和182例接受OVH的患者。主要终点是死亡，次要终点包括急性冠状动脉综合征、血运重建或其他主要不良心脏事件。还评估了无心绞痛情况、伤口并发症和患者自评健康状况。对已进行重复血管造影的病例进行了复查。
两组在人口统计学和围手术期特征方面匹配良好。EVH组和OVH组的全因死亡率分别为2/89（2%）和11/182（6%）。Cox对数秩分析显示这无统计学意义（p = 0.65），即使对住院死亡率进行调整后也是如此（p = 0.74）。在无心绞痛发生率（p = 1.00）、再次入院率（p = 0.78）或进一步使用抗心绞痛药物的需求方面（p = 1.00）没有差异。内镜组（EVH）的腿部伤口感染和并发症发生率显著降低（EVH：7%；OVH：28%；p = 0.0008），并且EVH组患者自评健康高分的偏态分布（61%，而开放组为52%）接近统计学意义（p = 0.06）。
虽然意识到这项小型回顾性研究的局限性，但我们对初步结果感到鼓舞，并认为我们的数据足以证明继续在我们中心为患者提供微创血管桥获取机会的合理性。仍需要更有力的证据来阐明内镜技术对血管桥通畅率和患者结局的影响，但在大型前瞻性随机试验结果出来之前，我们相信我们可以自信地为患者提供EVH的选择及其益处。
