 |
| Guest Commentary |
by Utz Kappert, MD
Cardiovascular Institute, Dresden, Germany |
|
|
Endoharvesting
The material used for coronary artery bypass surgery are arterial grafts and predominantly autologous veins, mainly the great saphenous vein which is taken in approximately 95% of all coronary artery bypass procedures. Despite the increasing use of arterial conduits for coronary revascularization, most coronary bypass operations still involve the use of the saphenous vein for one or more grafts.
Today, vein harvesting for the use in coronary artery bypass surgery can be performed using the conventional method with a long incision or the minimally invasive method using the bridging technique. Minimally invasive vein harvesting by endoscopic techniques has become feasible during recent years.
A variety of techniques have been developed in order to obviate longer skin incisions. With the use of any minimally invasive procedures, the formation of large skin flaps extended, bleeding and long exposure to the environment can be avoided. Wound complications from saphenous vein harvesting are common, and sometimes severe. To reduce this morbidity, we have adopted a technique of endoscopic vein harvesting, which allows complete harvest of the saphenous vein with excellent visualization, through minimal incisions.
At our hospital, this procedure is performed by physicians assistants while cardiac surgeons are harvesting arterial conduits. If segments of the great saphenous vein are harvested without using the endoscopic instruments, e.g., due to either lack of experience on behalf of the surgeon or the lack of endoscopic instruments, the saphenectomy is always performed using the bridging technique. The open conventional technique has been completely abandoned.
The use of minimally invasive vein harvesting techniques has reduced the morbidity associated with CABG. However, it may have led to an increased use of sequential coronary grafting techniques.
The endoscopic techniques does not prolong operative time when performed by experienced personnel, is likely to become the standard of care, and is associated with a definitely benefit for the patients.
« Minimally Invasive Conduit Harvesting for Coronary Bypass Grafting
« Join the discussion...
|
|
|
|