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Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.

ABSTRACT: Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience.During coronary artery bypass grafting, veins were harvested open (n=10) or by EVH (n=85) performed by experienced (>900 cases, >30/month) versus novice<100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography.Conduits from experienced (n=55) versus novice (n=30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p=0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p=0.05).High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.

SUBMITTER: Desai P

PROVIDER: S-EPMC4146432 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.

Desai Pranjal P Kiani Soroosh S Thiruvanthan Nannan N Henkin Stanislav S Kurian Dinesh D Ziu Pluen P Brown Alex A Patel Nisarg N Poston Robert R

The Annals of thoracic surgery 20110501 5

<h4>Background</h4>Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience.<h4>Methods</h4>During coronary artery bypass grafting, veins were harvested open (n=10) or by EVH (n=85) performed by experienced (>900 cases, >30/month) ver ...[more]

PMID: 21524447

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Project description:In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking.To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery.Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.Preservation of vein grafts in saline, blood, or buffered saline solutions.One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization.Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P?<?.001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P?<?.001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P?=?.001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P?<?.001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P?=?.08]) and blood (0.81 [0.63-1.03; P?=?.09]) solutions.Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions.clinicaltrials.gov Identifier: NCT00042081.

Dataset Information

Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.

Publications

Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.

Similar Datasets

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