Influence of saphenous vein access mode on outcome of coronary artery bypass grafting

doi:10.3877/cma.j.issn.2095-6568.2022.04.005

Abstract

Abstract:

Objective

To explore the effect of different methods of the great saphenous vein harvesting on the outcome of coronary artery bypass grafting (CABG).

Methods

This study was a retrospective cohort study. The clinical data of patients who underwent CABG in the Cardiovascular Surgery Department of Heart Center of Fuwai Central China Cardiovascular Hospital from March 2019 to April 2020 were collected retrospectively, such as age, gender, complications, etc. The patients were divided into two groups according to the way of obtaining the great saphenous vein: endoscopic group (obtaining the great saphenous vein through endoscope) and conventional group (traditional open access to the great saphenous vein). The operation time, number of CABG intraoperative flow of great saphenous vein graft, pulsatility index (PI), postoperative renal function impairment, postoperative hospital stay, postoperative stay in intensive care unit (ICU), lower extremity incision complications and graft patency rate, recurrent angina, myocardial infarction with follow-up time of [12-18] months were compared between the two groups.

Results

A total of 132 cases were collected with age (63.64±6.78) years old, 94 males (71.21%, 94/132) , including 58 in endoscopic group and 74 in conventional group. There was no significant difference between the two groups in gender, age, complications and other baseline data(P>0.05).There was no significant difference in terms of operation time [(355.50±75.92) min vs. (346.55±68.74) min, P=0.480], number of coronary artery bypass grafts [2.00(2.00,2.00) vs. 2.00(2.00,2.25), P=0.677], intraoperative flow of great saphenous vein graft [79.00(52.50,115.50) ml vs. 69.50(46.75,100.50) ml, P=0.196], pulsatility index (PI) of saphenous vein graft [1.55(1.38,2.20) vs. 1.60 (1.30,1.90), P=0.910], rate of renal function impairment (37.93% vs. 24.32%, P=0.091), postoperative hospital stay [10.00(8.00,15.25) d vs. 11.00(9.00,14.25) d, P=0.512] and postoperative stay in ICU[66.13(44.17,98.21) h vs. 66.38(43.81,95.46) h, P=0.757], between the two groups. There was no statistically significant difference with respect to the patency rate of graft (87.7% vs. 87.9% P=0.938), incidence of recurrent angina (10.34% vs. 10.81%, P=0.931), and myocardial infarction (10.34% vs. 6.76% P=0.534) in either group, no cases of death, percutaneous coronary intervention (PCI) or secondary CABG with follow-up time of [12-18] months. Lower extremity incision complications were lower in the endoscopic group than that in the conventional group [5.17%(12/74) vs. 16.22%(3/58)] with the difference statistically significant (P=0.047).

Conclusion

There was no difference in the effect of the mode of saphenous vein harvesting on the outcome of CABG, but endoscopic techniques can reduce the complication rate of lower extremity incisions.

Key words: Coronary artery bypass, Great saphenous vein, Endoscope, Flow of great saphenous vein graft, Pulsatility index

Chuanwei Li, Chang Ge, Zhaoyun Cheng, Qianjin Liu, Junjie Sun, Junlong Hu. Influence of saphenous vein access mode on outcome of coronary artery bypass grafting[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(04): 215-220.

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Figures/Tables 4

项目	内镜组	常规组	χ²/Z/T值	P值
例数（例）	58	74
男［例（%）］	42（72.41）	52（70.27）	0.073	0.787
年龄（岁， $x ¯ ± s$ ）	63.34 ± 7.129	63.88 ± 6.535	0.447	0.655
吸烟史［例（%）］	27（46.55）	25（33.78）	2.220	0.136
糖尿病［例（%）］	24（41.38）	23（31.08）	1.504	0.220
高脂血症［例（%）］	31（53.45）	34（45.95）	0.732	0.392
高血压［例（%）］	41（70.69）	46（62.16）	1.052	0.305
肥胖^a［例（%）］	8 （13.79）	14（18.92）	0.615	0.433
呼吸系统合并症^b［例（%）］	7 （12.07）	12（16.22）	0.454	0.501
冠心病家族史［例（%）］	15（25.86）	11（14.86）	2.486	0.115
陈旧性脑梗死［例（%）］	20（34.48）	17（22.97）	2.135	0.144
冠状动脉支架植入史［例（%）］	8（13.79）	6（8.11）	1.108	0.292
心肌梗死［例（%）］	18（31.03）	16（21.62）	1.507	0.220
超声心动图^c
左心室射血分数（%， $x ¯ ± s$ ）	57.72 ± 9.14	57.34 ± 8.84	-0.246	0.806
左心室舒张末容积（ml， $x ¯ ± s$ ）	124.24 ± 36.27	127.11 ± 36.35	0.450	0.653
左心室舒张末内径（mm， $x ¯ ± s$ ）	50.28 ± 6.39	50.71 ± 6.08	0.398	0.692
血肌酐^d（μmol/L， $x ¯ ± s$ ）	74.43 ± 21.17	72.86 ± 31.88	-0.338	0.736
心功能［例（%）］			3.378	0.066
Ⅱ级	19（24.14）	36（42.86）
Ⅲ/Ⅳ级	39（62.06）	38（46.22）

项目	内镜组	常规组	χ²/Z/T值	P值
例数（例）	58	74
男［例（%）］	42（72.41）	52（70.27）	0.073	0.787
年龄（岁， $x ¯ ± s$ ）	63.34 ± 7.129	63.88 ± 6.535	0.447	0.655
吸烟史［例（%）］	27（46.55）	25（33.78）	2.220	0.136
糖尿病［例（%）］	24（41.38）	23（31.08）	1.504	0.220
高脂血症［例（%）］	31（53.45）	34（45.95）	0.732	0.392
高血压［例（%）］	41（70.69）	46（62.16）	1.052	0.305
肥胖^a［例（%）］	8 （13.79）	14（18.92）	0.615	0.433
呼吸系统合并症^b［例（%）］	7 （12.07）	12（16.22）	0.454	0.501
冠心病家族史［例（%）］	15（25.86）	11（14.86）	2.486	0.115
陈旧性脑梗死［例（%）］	20（34.48）	17（22.97）	2.135	0.144
冠状动脉支架植入史［例（%）］	8（13.79）	6（8.11）	1.108	0.292
心肌梗死［例（%）］	18（31.03）	16（21.62）	1.507	0.220
超声心动图^c
左心室射血分数（%， $x ¯ ± s$ ）	57.72 ± 9.14	57.34 ± 8.84	-0.246	0.806
左心室舒张末容积（ml， $x ¯ ± s$ ）	124.24 ± 36.27	127.11 ± 36.35	0.450	0.653
左心室舒张末内径（mm， $x ¯ ± s$ ）	50.28 ± 6.39	50.71 ± 6.08	0.398	0.692
血肌酐^d（μmol/L， $x ¯ ± s$ ）	74.43 ± 21.17	72.86 ± 31.88	-0.338	0.736
心功能［例（%）］			3.378	0.066
Ⅱ级	19（24.14）	36（42.86）
Ⅲ/Ⅳ级	39（62.06）	38（46.22）

项目	内镜组	常规组	χ²/Z/T	P
例数（例）	58	74
手术时间（min， $x ¯ ± s$ ）	355.50 ± 75.92	346.55 ± 68.74	-0.709	0.480
旁路移植支数［支， M （IQR）］	2.00（2.00，2.00）	2.00（2.00，2.25）	-0.417	0.677
大隐静脉桥流量［ml， M （IQR）］	79.00（52.50，115.50）	69.50（46.75，100.50）	-1.293	0.196
大隐静脉桥搏动指数	1.55（1.38，2.20）	1.60（1.30，1.90）	-0.113	0.910
合并手术^a［例（%）］	13（22.41）	9（12.16）	2.460	0.117
是否体外循环［例（%）］			0.306	0.580
完全非体外循环	52（89.66）	64（86.49）
体外循环心脏停跳及体外循环并行辅助心脏不停搏	6（10.34）	10（13.51）

项目	内镜组	常规组	χ²/Z/T	P
例数（例）	58	74
手术时间（min， $x ¯ ± s$ ）	355.50 ± 75.92	346.55 ± 68.74	-0.709	0.480
旁路移植支数［支， M （IQR）］	2.00（2.00，2.00）	2.00（2.00，2.25）	-0.417	0.677
大隐静脉桥流量［ml， M （IQR）］	79.00（52.50，115.50）	69.50（46.75，100.50）	-1.293	0.196
大隐静脉桥搏动指数	1.55（1.38，2.20）	1.60（1.30，1.90）	-0.113	0.910
合并手术^a［例（%）］	13（22.41）	9（12.16）	2.460	0.117
是否体外循环［例（%）］			0.306	0.580
完全非体外循环	52（89.66）	64（86.49）
体外循环心脏停跳及体外循环并行辅助心脏不停搏	6（10.34）	10（13.51）

项目	内镜	常规组	χ²/Z/T	P
例数	58	74
术后肾功能损伤［例（%）］	22（37.93）	18（24.32）	2.850	0.091
术后住院天数［d， M （IQR）］	10.00（8.00，15.25）	11.00（9.00，14.25）	-0.656	0.512
术后心绞痛［例（%）］	6（10.34）	8（10.81）	0.007	0.931
术后心肌梗死［例（%）］	6（10.34）	5（6.76）		0.534^a
二次冠状动脉旁路移植手术［例］	0	0
术后住ICU时间［h， M （IQR）］	66.13（44.17，98.21）	66.38（43.81，95.46）	-0.309	0.757
术后死亡（例）	0	0
术后经皮冠状动脉介入治疗（例）	0	0
术后下肢切口并发症^b［例（%）］	3（5.17）	12（16.22）		0.047

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