Department of Cardiothoracic Surgery, 26842Ome Municipal General Hospital, Tokyo, Japan.
Department of Diagnostic Pathology, 26842Ome Municipal General Hospital, Tokyo, Japan.
Innovations (Phila). 2022 Jan-Feb;17(1):56-63. doi: 10.1177/15569845221074463.
Saphenous vein grafts (SVGs) are widely used as bypass conduits in coronary artery bypass grafting. Compared with the conventional technique, the "no-touch" technique, wherein the saphenous veins are harvested with the surrounding tissue, may improve SVG patency; however, there are concerns regarding wound complications. To address this issue, we describe our novel no-touch technique with separate skin incisions using a long-shafted ultrasonic scalpel and report the clinical outcomes.
We enrolled 66 male patients who underwent isolated coronary artery bypass grafting between April 2016 and April 2021. There were 30 and 36 patients treated using our no-touch technique and the conventional technique, respectively. The participants underwent coronary angiography before discharge and were followed clinically. SVG samples were taken for pathological examination.
SVGs harvested using our no-touch technique displayed preservation of the vessel wall structure and surrounding tissues. Our no-touch technique demonstrated no inferiority in patency compared with the conventional technique, and there was no SVG occlusion in the no-touch group. The frequency of leg wound complications was higher in the no-touch group than the conventional group, but no surgical site infections and severe complications occurred in the no-touch group.
SVGs harvested using our novel no-touch technique had similar pathological characteristics to those harvested using the original no-touch technique reported previously. Our no-touch technique maintained SVG patency and caused no severe wound complications. However, a large-scale, longitudinal study is required to accurately assess the clinical outcomes of our no-touch technique.
大隐静脉(SVG)作为冠状动脉旁路移植术的旁路移植物被广泛应用。与传统技术相比,“非接触”技术可提高 SVG 的通畅率,即在采集大隐静脉时保留其周围组织;然而,该技术存在切口愈合不良的风险。为解决这一问题,我们描述了一种使用长柄超声刀进行单独皮肤切口的新型非接触技术,并报告了其临床结果。
我们纳入了 2016 年 4 月至 2021 年 4 月期间接受单纯冠状动脉旁路移植术的 66 名男性患者。其中 30 名患者采用我们的非接触技术,36 名患者采用传统技术。所有患者在出院前均接受冠状动脉造影检查,并进行临床随访。采集 SVG 样本进行病理学检查。
采用我们的非接触技术采集的 SVG 保留了血管壁结构和周围组织。与传统技术相比,我们的非接触技术在通畅率方面没有劣势,且非接触组无 SVG 闭塞。非接触组的腿部伤口并发症发生率高于传统组,但非接触组无手术部位感染和严重并发症发生。
与先前报道的原始非接触技术相比,我们的新型非接触技术采集的 SVG 具有相似的病理学特征。我们的非接触技术保持了 SVG 的通畅率,且未引起严重的伤口并发症。然而,需要进行大规模、纵向研究以准确评估我们的非接触技术的临床结果。