Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting.

Bibleraaj, Bhuvaneswari, Critchley, William, Nair, Janesh, Malagon, Ignacio, Carey, John, Barnard, James B, Watermouth, Paul, Venkateswaran, Rajamiyer, Fildes, James, Caress, Ann and Yonan, Nizar (2017) Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting. Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery, 12 (5). pp. 320-328. ISSN 1556-9845 DOI https://doi.org/10.1097/IMI.0000000000000405

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To assess whether the use of carbon dioxide (CO2) insufflation has any impact on integrity of long saphenous vein comparing two types of endoscopic vein harvesting (EVH) and traditional open vein harvesting. Methods: A total of 301 patients were prospectively randomized into three groups. Group 1 control arm of open vein harvesting (OVH)(n=101), Group 2 closed tunnel (CO2) EVH (CT-EVH) (n=100) and Group 3 open tunnel (CO2) EVH (OT-EVH) (n=100). Each group was assessed to determine the systemic level of Partial arterial CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. Three blood samples were obtained at baseline, 10 minutes after start of EVH and 10 minutes after the vein was retrieved. Vein samples were taken immediately after vein harvesting without further surgical handling to measure the histological level of endothelial damage. A modified validated endothelial scoring system was used to compare the extent of endothelial stretching and detachment. Results: The level of end tidal CO2 was maintained in the OT-EVH and OVH groups but increased significantly in the CT-EVH group (p=0.451, p=0.385 and p<0.001). Interestingly, partial arterial CO2 also did not differ over time in the OT-EVH group (p=0.241) whereas PaCO2 reduced significantly over time in the OVH group (p=0.001). A profound increase in PaCO2 was observed in the CT-EVH group (p<0.001). Consistent with these patterns, only the CT-EVH group demonstrated a sudden drop in pH over time (p<0.001) whereas pH remained stable for both OT-EVH and OVH groups (p=0.105 and p=0.869 respectively). Endothelial integrity was better preserved in the OVH group compared to OT-EVH or CT-EVH groups (p=0.012) and was not affected by changes in CO2 or low pH. Significantly greater stretching of the endothelium was observed in the open tunnel endoscopic OT-EVH group compared to the other groups (p=0.003). Conclusions: This study demonstrated that the different vein harvesting techniques impact on endothelial integrity; however this does not appear to be related to the increase in systemic absorption of carbon dioxide or to the pressurised endoscopic tunnel. The open tunnel endoscopic harvesting technique vein had more endothelial stretching compared to the closed tunnel endoscopic technique; this may be due to manual dissection of the vein. Further research is required to evaluate the long term clinical outcome of these vein grafts.

Item Type: Article
Uncontrolled Keywords: Coronary artery bypass surgery, Open vein harvesting, Closed tunnel endoscopic vein harvesting, Open tunnel endoscopic vein harvesting, endothelial integrity.
Subjects: R Medicine > R Medicine (General)
Divisions: Nursing and Midwifery
Date Deposited: 10 Jul 2017 15:57
URI: http://repository.edgehill.ac.uk/id/eprint/9231

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