A NEW ENDOSCOPIC VEIN HARVESTING TECHNIQUE FOR CORONARY ARTERY BYPASS SURGERY

During coronary artery bypass surgery, the great saphenous vein is traditionally harvested via soft tissue dissection along the entire length of the extracted conduit, which is very traumatic and leads to the development of wound complications. The emergence of endoscopic harvesting techniques has substantially could reduce the frequency of the latter. However, the data published and the results of meta-analyses indicate the worst mid-term patency of endoscopically harvested shunts. This is associated with an excessive mechanical impact on the vein wall and with carbon dioxide insufflation. Vein harvesting in the flap with the surrounding tissues, which is called a «notouch» technique, allows virtually eliminating any direct mechanical effect on the venous conduit wall, ensuring the morphofunctional integrity of a future shunt. Due to this, the procedure has the best medium- and long-term results, but it is more traumatic for the lower limb. The technique developed at the Research Institute of Cardiology, Tomsk National Research Medical Center, to endoscopically harvest the great saphenous vein in the flap with the surrounding tissues and that for its traditional open harvesting underwent comprehensive comparative assessment. The study enrolled 315 patients who were prospectively randomized into endoscopic (n = 156) and open (n = 159) vein harvesting groups. Intraoperative data, postoperative clinical course, and features of wound healing were analyzed. Endoscopic harvesting of the greater saphenous vein was shown to reduce the total duration of interventions and the number of wound complications. Thus, the developed endoscopic harvesting technique not only allows one to adhere to the «no-touch» technique, but is also less traumatic for the lower extremities.

no-touch, cardiology, surgery, coronary artery bypass surgery, endoscopic vein harvesting, no-touch, wound complications