Muharrem KOÇYİĞİT, Cem ALHAN, Leyla KILIÇ, Ahmet Ümit GÜLLÜ, Şahin ŞENAY, Egemen ERSİN, Özlem ÇELİK, Emine GÜZEL, Neriman Özge ÇALIŞKAN

Endoskopik ven hazırlama ile koroner cerrahinin uzun dönem sonuçları

Amaç: Bu çalışmada, endoskopik ven hazırlama tekniği ile izoleveya eş zamanlı koroner arter baypas greftlemenin erken ve uzundönem sonuçları değerlendirildi. Çalışma planı: Kasım 2012 - Mayıs 2017 tarihleri arasındaeş zamanlı işlemler ile birlikte veya tek başına, endoskopikven hazırlama tekniği kullanılarak koroner arter baypas greft leme yapılan toplam 324 hasta (259 erkek, 65 kadın; ort. yaş:63.2±9.8 yıl; dağılım 36-91 yıl) retrospektif olarak incelendi.Kardiyovasküler veya serebral olaylar, kardiyak girişimler vekoroner anjiyografi görüntüleri dahil olmak üzere hastalarınameliyat sonrası erken dönem sonuçları ve uzun dönem takipverileri kaydedildi. Bulgular: İzole koroner cerrahi hastalarında ortalama lojistikEuroSCORE 3.99 (0.8-81) iken mortalite oranı %0.9; eşlik edencerrahi prosedür varlığında ise ortalama lojistik EuroSCORE13.34 (1.5-76.4) iken mortalite oranı %1.5’tir. Uzun dönem veri ler 288 hastanın ortalama 59.6 ay (7-90) boyunca takip edilmesisonucu elde edildi. Bu süre zarfında 22 hastaya (%7.6) kontrolveya tedavi için koroner anjiyografi yapıldı, 12 hastada (%4.2)revaskülarizasyon gereksinimi oldu ve hastaların hiçbirine yeni den koroner cerrahi yapılmadı. Sonuç: Çalışma sonuçlarımız koroner arter baypas greftlemesırasında endoskopik ven hazırlama tekniğinin deneyimli ellerdegüvenli olduğunu göstermektedir.

Long-term results of coronary surgery with endoscopic vein harvesting

Background: In this study, we aimed to evaluate early and long term outcomes of both isolated or concomitant coronary arterybypass grafting with the endoscopic vein harvesting technique. Methods: Between November 2012 and May 2017, a total of324 patients (259 males, 65 females; mean age: 63.2±9.8 years;range, 36 to 91 years) who underwent coronary artery bypassgrafting, with or without concomitant procedures, using theendoscopic vein harvesting technique were retrospectively ana lyzed. Early postoperative outcomes and long-term follow-updata of the patients, such as cardiovascular or cerebral events,cardiac reinterventions, and the images of coronary angiogra phy were recorded. Results: Median logistic EuroSCORE and in hospital mor tality was 3.99 (0.8-81) vs. 0.9% for isolated coronarysurgery and 13.34 (1.5-76.4) vs. 1.5% for concomitant proce dures. The long-term data could be obtained in 288 patientswith a median of 59.6 (7-90) months of follow-up. Duringthis period, 22 (7.6%) patients underwent coronary angi ography for control or treatment, 12 (4.2%) patients neededrevascularization, and none of the patients underwent redocoronary surgery. Conclusion: Our study results suggest that the endoscopic veinharvesting technique during coronary artery bypass grafting issafe in experienced hands.

PDF

___

1. Connolly MW, Poston RS. Endoscopic versus open veingraft harvesting. N Engl J Med 2009;361:1907-8.
2. Aranki SF, Shopnick B. Endoscopic versus open vein-graft harvesting. N Engl J Med 2009;361:1907.
3. Soni MK, Williams L, Raja SG. Use of endoscopic vein harvesting (EVH) during coronary artery bypass grafting in United Kingdom: The EVH survey. Int J Surg 2019;69:146-51.
4. Harky A, Balmforth D, Shipolini A, Uppal R. Is endoscopic long saphenous vein harvesting equivalent to open harvesting technique in terms of graft patency? Interact Cardiovasc Thorac Surg 2017;25:323-6.
5. Zenati MA, Shroyer AL, Collins JF, Hattler B, Ota T, Almassi GH, et al. Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. J Thorac Cardiovasc Surg 2011;141:338-44.
6. Okten M, Ariturk C, Gullu AU, Senay S, Toraman F, Karabulut H, et al. Techniques for endoscopic vessel harvesting. Turkiye Klinikleri J 2015;7:54-8.
7. Desai P, Kiani S, Thiruvanthan N, Henkin S, Kurian D, Ziu P, et al. Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency. Ann Thorac Surg 2011;91:1385-91.
8. Kiani S, Desai PH, Thirumvalavan N, Kurian DJ, Flynn MM, Zhao X, et al. Endoscopic venous harvesting by inexperienced operators compromises venous graft remodeling. Ann Thorac Surg 2012;93:11-7.
9. Sabik JF 3rd. Understanding saphenous vein graft patency. Circulation 2011;124:273-5.
10. Deppe AC, Liakopoulos OJ, Choi YH, Slottosch I, Kuhn EW, Scherner M, et al. Endoscopic vein harvesting for coronary artery bypass grafting: A systematic review with metaanalysis of 27,789 patients. J Surg Res 2013;180:114-24.
11. Athanasiou T, Aziz O, Al-Ruzzeh S, Philippidis P, Jones C, Purkayastha S, et al. Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis. Eur J Cardiothorac Surg 2004;26:1015-26.
12. Crouch JD, O'Hair DP, Keuler JP, Barragry TP, Werner PH, Kleinman LH. Open versus endoscopic saphenous vein harvesting: Wound complications and vein quality. Ann Thorac Surg 1999;68:1513-6.
13. Rao C, Aziz O, Deeba S, Chow A, Jones C, Ni Z, et al. Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique? J Thorac Cardiovasc Surg 2008;135:809-15