Comparison Of The Short-term Effects Between The Endoscopic And No-touch Technique In Coronary Artery Bypass Grafting Surgery

ObjectiveTo compare the short-term effects between endoscopic and no-touch saphenous vein harvesting technique applied to coronary artery bypass grafting(CABG).MethodsA total of 88 patients with coronary heart disease(CHD)received CABG on the basis of the inclusion and exclusion criteria from January 2018 to February 2020.According to the great saphenous vein harvesting techniques,patients were divided into endoscopic vein harvesting(EVH)group of 45 cases and No-touch group of 43 cases.The preoperative baseline data(age,blood pressure,serum lipid level,etc),intraoperative data(duration of operation,number of grafts,flow of bypass conduits including great saphenous vein graft,etc),postoperative data(ventilator support time,duration of postoperative stay in intensive care unit,lower limbs incision complications,etc)and 1 year postoperative follow-up data(graft patency rate,recurrence of angina,repeat revascularization,myocardial infarction,etc)were compared and analyzed by statistical method between the two groups to evaluate the short-term clinical effects between endoscopic harvesting technique and no-touch harvesting technique in coronary artery bypass graft surgery.ResultsPreoperative baseline data of the endoscopic harvesting group and the no-touch harvesting group including ratio of male to female(32:13 vs.37:6,p=0.089),age(53.93±3.47 years vs.52.21±6.28 years,p=0.112),preoperative respiratory comorbidity(15.6%vs.11.6%,p=0.591),smoking history(68.9%vs.81.4%,p=0.176),family history of coronary heart disease(33.3%vs.30.2%,p=0.755),diabetes mellitus(35.6%vs.23.3%,p=0.206),hypertension(73.3%vs.60.5%,p=0.199),hyperlipidemia(48.9%vs.48.8%,p=0.996),previous cerebral infarction(22.2%vs.16.3%,p=0.480),coronary artery stent implantation history(15.6%vs.9.3%,p=0.375),old myocardial infarction(40%vs.20.9%,p=0.052),angina pectoris(80.0%vs.72.1%,p=0.384),obesity(20.0%vs.37.2%,p=0.074),arrhythmia(40.0%vs.20.9%,p=0.052),impairment of renal function(2.2%vs.4.7%,p=0.612)and cardiac function grade had no statistical difference(p>0.05).The data did not differ statistically significantly(p>0.05)in terms of operative time(6.20±1.19 hours vs.6.22±1.31 hours,p=0.957),use of the proximal aortic anastomosis auxiliary device(75.6%vs.58.1%,p=0.082),number of the saphenous vein grafts(2.31 ± 0.73 vs.2.00 ± 0.85,p=0.068),flow of the saphenous vein grafts(56.08± 13.92 ml/min vs.51.32 ± 15.68 ml/min,p=0.135),pulsation index of the saphenous vein graft(1.98±0.73 vs.2.25 ± 0.61,p=0.064),postoperative ventilation time(34.13 ± 33.52 hours vs.27.20±16.15 hours,p=0.223),postoperative stay in the intensive care unit(67.01± 40.08 hours vs.55.76 ± 31.48 hours,p=0.148),duration of postoperative hospital stay(12.02±5.46 days vs.11.44± 3.60 days,p=0.559),combined surgery(13.3%vs.14.0%,p=0.932),postoperative arrhythmias(22.2%vs.11.6%,p=0.186).Postoperative complications of lower extremity incision incidence(8.9%vs.27.9%,p=0.021)was lower in the endoscopic group and the difference was statistically significant(p<0.05).Incidence of postoperative myocardial injury and renal function injury had no statistical significance(p>0.05).No postoperative dialysis cases in either group.There was no significant difference in cardiac function indexes after operation.The rate of postoperative follow-up in terms of proportion of cases undergoing coronary angiography was not statistically significant between the two groups(36/45 vs.37/43,p=0.451)1 year after surgery(p>0.05).The incidence of angina pectoris 1 year after surgery was higher in the endoscopic group than that in the no-touch group(5/45 vs.2/43,p=0.435),but the difference was not statistically significant(p>0.05).The endoscopic group had a lower rate of graft patency and the difference was statistically significant(p<0.05).There was no death,recurrent myocardial infarction,re-do coronary artery bypass surgery or percutaneous coronary intervention(PCI)in the two groups 1 year after surgery.ConclusionThere was no difference between the endoscopic harvesting technique and the notouch harvesting technique for the harvesting of the saphenous vein for CABG in terms of myocardial injury,renal function injury,flow and pulsatility index of graft.Endoscopic harvesting technique can reduce the complication incidence of lower extremity incision,but the patency rate of graft one year after operation is lower than that of no-touch technique group.There was no statistically difference between the two techniques in recurrent angina,recurrent myocardial infarction,redo CABG surgery to re-establish blood flow one year after coronary artery bypass grafting.