Inaba Yu, Yamazaki Masataka, Ohono Masatoshi, Yamashita Kentaro, Izumida Hiroaki, Hayashi Kanako, Takahashi Tatsuo, Kimura Naritaka, Ito Tsutomu, Shimizu Hideyuki
Department of Cardiovascular Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2020 Mar;68(3):248-253. doi: 10.1007/s11748-019-01186-4. Epub 2019 Aug 2.
Although the patency of internal artery grafts in coronary artery bypass grafting (CABG) is superior to that of saphenous vein grafts (SVGs), good long-term patency rates have been reported with SVGs harvested using the no-touch technique. Here, we report the early results of CABG with no-touch SVGs (NT-SVGs) along with the precautions required while handling these grafts.
This retrospective study included 41 patients who underwent CABG with NT-SVGs between May 2016 and March 2018. NT-SVGs were harvested with minimal electric scalpel use, and post-harvesting vascular overdilation with a syringe was not performed. Blood with heparinized saline was used to prevent vascular endothelial damage. A drain was inserted into the SVG harvest site, which was closed with a single interrupted suture, and elasticated bandage and compression stockings were used to prevent fluid retention and avoid delayed wound healing.
There was no case of postoperative thoracotomy due to bleeding or myocardial infarction, and postoperative graft assessment confirmed graft patency in all patients, with a little mismatch between the diameters of SVG and the anastomotic vessel. Delayed wound healing at the graft harvest site seemed to improve after introducing the above procedures.
Early results of CABG with NT-SVGs were good. Some precautions must be taken during harvesting and anastomosis. Taking precautions described in this study may help reduce the risk of perioperative complications and make the no-touch technique the standard procedure for harvesting SVGs for CABG.
尽管冠状动脉旁路移植术（CABG）中使用的内动脉移植物通畅率优于大隐静脉移植物（SVG），但据报道，采用非接触技术获取的SVG具有良好的长期通畅率。在此，我们报告非接触SVG（NT-SVG）行CABG的早期结果以及处理这些移植物时所需的注意事项。
这项回顾性研究纳入了2016年5月至2018年3月期间接受NT-SVG行CABG的41例患者。NT-SVG的获取尽量减少电刀的使用，获取后不进行血管过度扩张。使用含肝素盐水的血液以防止血管内皮损伤。在SVG获取部位插入引流管，用单间断缝合法关闭切口，并使用弹力绷带和加压袜以防止液体潴留并避免伤口愈合延迟。
没有因出血或心肌梗死而进行术后开胸手术的病例，术后移植物评估证实所有患者的移植物均通畅，SVG与吻合血管的直径略有不匹配。采用上述方法后，移植物获取部位的伤口愈合延迟情况似乎有所改善。
NT-SVG行CABG的早期结果良好。在获取和吻合过程中必须采取一些预防措施。采取本研究中描述的预防措施可能有助于降低围手术期并发症的风险，并使非接触技术成为CABG中获取SVG的标准操作程序。
