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Thorac Cardiovasc Surg 2001 Thema: Permanent Poster |
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Düsterhöft V, Bauer M, Zurbrügg HR, Buz S, Alafouri D, Hetzer R
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Subject: Harvesting of the great saphenous vein for coronary artery bypass grafting is usually performed through long cutaneous incisions. This approach is often associated with complications in wound healing, insufficient cosmetic results and delay in mobilization of the patients. Therefore, several minimal-invasive methods were developed. The aim of the study was to compare the results of our minimally-invasive technique with the traditional method.
Material and Methods: We report our experience of minimally-invasive direct vision harvesting of the great saphenous vein with the Aesculap retractor system by performing 3-4 small cutaneous incisions. The device is compose of a blade coupled to a light source and allows dissection of the vein under direct vision of the surgeon. We scheduled 201 patients for elective CABG prospectively computerized randomized to undergo vein harvesting by either the minimally-invasive technique (group A, n=96, age 68.2±9.1 years, male 53.1%) or by the traditional technique (group B, n=105, age 66.1±8.3 years, male 63.5 %). There were no differences between group A and B regarding the age, gender, severity of the coronary artery disease and the risk profile of the patients predisposing for wound healing complications (diabetes, obesity, peripheral arterial disease, renal failure, chronic use of steroids). We classified leg-wound infections in terms of mild, moderate and severe wound healing disorders.
Results: Between group A and B were no differences with regard to the length of vein harvested (41.8 cm±6.4 cm vs. 42.6 cm±5.9 cm, p=0.32), the number of bypasses performed (2.2±0.7 vs. 2.1±0.5, p = 0.24) and the total surgical time (228.6±60.4 min vs. 228.7±62.4 min, p=0.99). The time for minimally-invasive harvesting of the great saphenous vein is only slightly increased (group A 43.2±18.8 min vs. group B 41.8±13.4 min, p=0.15).
Moderate and severe leg-wound healing disorders occurred in 4 of 96 patients of group A (4.2%) vs. 11 of 105 patients of group B (10.5%) with significant difference. Subjective the patients in group A agreed more with the postoperative cosmetic result. In both groups there were no bypass-related early postoperative complications.
Conclusions: The minimally-invasive direct vision harvesting of the great saphenous vein is an attractive alternative to the traditional open-harvesting technique. This procedure results in fewer wound complications and shows a much better cosmetic outcome. The total operation time by using the minimally-invasive technique is not increased.
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