The Great Saphenous Vein (GSV) is the most commonly used conduit for Coronary Artery Bypass Grafting (CABG). The referenced standard method of harvesting the GSV is by way of the open surgical technique. Depending on the required graft length, the average incision will vary between 20 and 40 centimetres. Therefore 80% of the donor-site infections are diagnosed after discharge, for instance by the patient’s general physician or cardiologist. Furthermore, wound complications are often found to be responsible for additional surgery, prolonged hospital stay, increased hospital costs, and in some cases permanent disability.
The introduction of Endoscopic Vein Harvesting (EVH) in 1996 seemed a welcome contribution to achieve goals set in modern cardiac surgery, namely, making cardiac surgery less invasive and promote earlier recovery after surgery. Now approximately 15 years after its introduction EVH has conquered an important place in standard clinical care (80% of the CABG procedures conducted in the USA use EVH).
The patients who are suffering from coronary heart disease as their coronary arteries are not amenable to angioplasty. For most CABG operations, the common conduit for bypassing the coronary artery is still the Great Shapenous Veins harvested from the patients’ own limbs.
Conventional Procedure- In the majority of CABG operations, either artery (Left Internal Mammary Artery & Right Internal Mammary Artery) or venous grafts are made. Veins from the legs are taken out (using the conventional method) by making long incisions on the limbs equal to the length of veins required for a bypass graft. For instance, if we need 80cm of veins for four bypasses then the skin of the leg needs to be exposed for 80cm to expose the vein for harvesting.
How DESUN’s Cardiac Team is revolutionising Heart Bypass Surgery by adopting Endoscopic Vein Harvesting for Coronary Bypass Grafting
Constantly implementing techniques based on latest global standards has transformed DESUN Hospital Services from Good to Great !
In the previous issue of DESUN Update we had discussed about how Desun saved a serious Trauma Patient. In this issue we shall discuss more on the Coronary Bypass Grafting at Desun.
This can evoke fear in the patient as they are always scared of the long incisions, poor cosmetic appearance and the pain associated with these incisions. These wounds can also take some time to heal. Moreover, wound complications especially in diabetic and obese patients are high and may require a long hospital stay. This method can cause extra cost to the patient if complications occur.
To overcome all these complications associated with the conventional method, a new approach is being adopted across the world. This method is called as Endoscopic Vein Harvesting (EVH) and is performed by our Cardiovascular or Heart Transplant Surgeons.
Cosmetic Result and Quality of Life :
Since the scare after EVH is considerably smaller, it is not surprising that patients are significantly more satisfied with the cosmetic result after EVH then after the traditional harvest.
Less Donor-Site Infection & Faster Post-OP Recovery:
EVH reduces the number of donor-site infections because it causes less trauma to the surrounding tissue, preserves tissue perfusion, and is less likely to create vital tissue flaps. It requires a single 1 or 2 cm incision to harvest the whole long length of a vein and any length of the vein can be harvested for CABG by EVH. This reduces the hospital stay, no wound complications, less post-operative pain, and better acceptance by the patient.
The procedure requires the use of minimally invasive instruments and a telescopic camera to internally cut, view and seal side branches and remove the healthy blood vessel with minimum damage to the vessel and it surrounding tissues.
The incision size and minimal dissection of the surrounding tissues of the leg significantly reduce the blood loss.
EVH is being a rapidly adopted as a routine surgical procedure at many centers worldwide for harvesting the leg veins for bypass surgeries.
Many types of heart procedures may be conducted with minimally invasive heart surgery. Minimally invasive heart procedures may include:
Mitral valve repair and replacement
Tricuspid valve repair and replacement
Aortic valve replacement
Atrial septal defect
Ventricular septal defect surgery
Coronary artery bypass surgery
Saphenous vein harvest for coronary artery bypass surgery
Minimally invasive heart surgery isn’t an option for everyone, but it can offer potential benefits in those for whom it’s appropriate. Potential benefits of minimally invasive heart surgery compared with open-heart surgery may include:
Less blood loss
Lower risk of infection
Reduced trauma and pain
Shorter time in the hospital, faster recovery and quicker return to normal activities
Smaller, less noticeable scars.