Wang Huishan, Wu Haibo, Jiang Hui, Wang Zengwei, Potapov Evginij, Stepanenko Alexander
Division of Cardiovascular Surgery, Northern Hospital, Shenyang, People's Republic of China.
Heart Surg Forum. 2011 Oct;14(5):E291-6. doi: 10.1532/HSF98.20111035.
We aimed to investigate the initial experience of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in Chinese patients.
Forty patients scheduled for isolated CABG were prospectively randomized into an EVH group (n = 20) and an open vein harvesting (OVH) group (n = 20). Clinical data were collected, and all of the vein grafts were assessed by macroscopic appearance, histologic quality (endothelial integrity), and functional characteristics of endothelial nitric oxide synthase.
The 2 groups were similar with respect to hospital mortality (EVH group, 0; OVH group, 1; P = 1). There were no postoperative myocardial infarctions in either group and no deaths or reinterventions in either group during the follow-up period. Harvesting times in the 2 groups were similar (EVH, 12.15 ± 2.32 min; OVH, 12.55 ± 2.11 min; P = .571). Three patients in the EVH group were converted to a partly open or skin-bridge technique. Electrocautery at least 2 mm distal to the origin of the side branch was the safety margin.
The use of EVH in Chinese patients was not related to adverse events and may be safely used for CABG procedures. Preoperative duplex mapping, systemic heparinization before harvesting, minimal surgical manipulation, and sectioning of side branches at least 2 mm distal to the origin may help improve the quality of vein grafts harvested with EVH and maximize the benefit of this less-invasive technique.
我们旨在研究中国患者行冠状动脉旁路移植术（CABG）时内镜下取静脉（EVH）的初步经验。
40例计划行单纯CABG的患者被前瞻性随机分为EVH组（n = 20）和开放取静脉（OVH）组（n = 20）。收集临床数据，并通过肉眼外观、组织学质量（内皮完整性）和内皮型一氧化氮合酶的功能特性对所有静脉移植物进行评估。
两组在医院死亡率方面相似（EVH组为0；OVH组为1；P = 1）。两组均无术后心肌梗死，随访期间两组均无死亡或再次干预情况。两组的取静脉时间相似（EVH组为12.15±2.32分钟；OVH组为12.55±2.11分钟；P = 0.571）。EVH组有3例患者转为部分开放或皮桥技术。侧支起源远端至少2 mm处进行电灼是安全边界。
在中国患者中使用EVH与不良事件无关，可安全用于CABG手术。术前进行双功超声造影、取静脉前全身肝素化、尽量减少手术操作以及在侧支起源远端至少2 mm处进行分支切断，可能有助于提高EVH获取的静脉移植物质量，并使这种微创技术的益处最大化。
