Multiple Skin Bridging for No-Touch Saphenous-Vein Grafts Harvesting Can Reduce Wound Morbidity

Multiple Skin Bridging for No-Touch SV Harvest

Authors

  • Kang Zhou, MD Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
  • Xiaoke Qi, MD Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
  • Shijie Wei, MD Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
  • Xinmin Zhou, MD, PhD Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
  • Yuan Zhao, MD, PhD 2nd xiangya hospital

DOI:

https://doi.org/10.1532/hsf.3875

Keywords:

Minimally Invasive, Saphenous Vein, Skin Bridging, Wound Morbidity

Abstract

Background: Reducing the leg wound morbidity is crucial for the patients undergoing coronary artery bypass grafting (CABG) with great saphenous vein (SV) grafts harvested by no-touch (NT) technique. This study was to summarize the experience of skin bridging technique for reducing wound morbidity and the influence of it on one-year bypass graft patency.

Methods: According to skin bridging or not, harvesting times, graft length, number of bleeding branches, postoperative subjective perception assessment scale (ASEPSIS) scores and one-year patency rate were analyzed.

Results: From June 2018 to February 2019, 60 patients underwent CABG with SV grafts either with open-incision NT or skin bridging NT (30 in each group). There were no significant differences in age (71.4 ± 5.1 years vs. 68.9 ± 5.5 years) or graft length (23.3 ± 1.1 cm vs. 23.9 ± 1.3 cm) between the two groups. The bridging/NT group had a significantly longer harvest time (38.5 ± 4.9 min vs. 18.5 ± 2.6 min; P < 0.001) and a significantly greater number of bleeding branches (1.9 ± 1.2 vs. 0.8 ± 0.8; P < 0.001) than the open NT group. The open NT group had a significantly higher ASEPSIS score (23.8 ± 2.0 vs. 15.7 ± 2.6; P < 0.001). There was no significant difference in patency rate at one-year follow-up.

Conclusion: Obtaining the SV by the combined NT/discontinuous skin bridging technique is a satisfactory method for patients who underwent CABG. This method has important clinical significance in reducing wound morbidity in the harvest of NT grafts.

References

Albäck A, Saarinen E, Venermo M. 2016. Vein harvesting and techniques for infrainguinal bypass. J Cardiovasc Surg (Torino). 57(2):292-301.

Black EA, Campbell RK, Channon KM, Ratnatunga C, Pillai R. 2002. Minimally invasive vein harvesting significantly reduces pain and wound morbidity. Eur J Cardiothorac Surg. 22(3):381-386.

Deb S, Singh SK, de Souza D, Chu M, Whitlock R, Meyer SR, et al. 2019. SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449). J Cardiothorac Surg. 14(1):85.

Inaba Y, Yamazaki M, Ohono M, Yamashita K, Izumida H, Hayashi K, et al. 2019. No-touch saphenous vein graft harvesting technique for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg.

Janiec M, Friberg Ö, Thelin S. 2018. Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein grafts. J Cardiothorac Surg. 13(1):122.

Johansson B, Samano N, Souza D, Bodin L, Filbey D, Mannion JD, et al. 2015. The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial. Open Heart. 2(1):e000204.

Khan UA, Krishnamoorthy B, Najam O, Waterworth P, Fildes JE, Yonan N. 2010. A comparative analysis of saphenous vein conduit harvesting techniques for coronary artery bypass grafting--standard bridging versus the open technique. Interact Cardiovasc Thorac Surg. 10(1):27-31.

Kim YH, Oh HC, Choi JW, Hwang HY, Kim KB. 2017. No-Touch Saphenous Vein Harvesting May Improve Further the Patency of Saphenous Vein Composite Grafts: Early Outcomes and 1-Year Angiographic Results. Ann Thorac Surg. 103(5):1489-1497.

Ma GT, Liu XR, Zhang CJ, Liu JZ, Miao Q, Jiang C, et al. 2015. [Endoscopic Saphenous Vein Harvesting versus Open Vein Harvesting Techniques]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 37(4):420-423.

McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. 2017. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiol Ther. 6(2):203-223.

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2019. [2018 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS)]. G Ital Cardiol (Rome). 20(7-8 Suppl 1):1S-61S.

Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. 2017. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 69(17):2212-2241.

Samano N, Dashwood M, Souza D. 2018. No-touch vein grafts and the destiny of venous revascularization in coronary artery bypass grafting-a 25th anniversary perspective. Ann Cardiothorac Surg. 7(5):681-685.

Samano N, Geijer H, Bodin L, Arbeus M, Mannion JD, Dashwood M, et al. 2017. The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery. J Thorac Cardiovasc Surg. 154(2):457-466.e3.

Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. 2015. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg. 150(4):880-888.

Samano N, Souza D, Pinheiro BB, Kopjar T, Dashwood M. 2020. Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance. Braz J Cardiovasc Surg. 35(1):91-99.

Souza D. 1996. A new no-touch preparation technique. Technical notes. Scand J Thorac Cardiovasc Surg. 30(1):41-44.

Souza DS, Dashwood MR, Tsui JC, Filbey D, Bodin L, Johansson B, et al. 2002. Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques. Ann Thorac Surg. 73(4):1189-1195.

Souza DS, Johansson B, Bojö L, Karlsson R, Geijer H, Filbey D, et al. 2006. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg. 132(2):373-378.

Souza D, Samano N. 2016. Long-term patency versus leg wound healing in coronary artery bypass surgery: Surgical aspects of the no-touch harvesting technique. J Thorac Cardiovasc Surg. 151(1):276.

Wilson AP, Treasure T, Sturridge MF, Grüneberg RN. 1986. A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis. Lancet. 1(8476):311-313.

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 35(37):2541-2619.

Published

2021-06-10

How to Cite

Zhou, K., Qi, X., Wei, S., Zhou, X., & Zhao, Y. (2021). Multiple Skin Bridging for No-Touch Saphenous-Vein Grafts Harvesting Can Reduce Wound Morbidity: Multiple Skin Bridging for No-Touch SV Harvest. The Heart Surgery Forum, 24(3), E496-E501. https://doi.org/10.1532/hsf.3875

Issue

Section

Articles