No-touch saphenous vein graft harvesting technique for coronary artery bypass grafting.
- 作者列表："Inaba Y","Yamazaki M","Ohono M","Yamashita K","Izumida H","Hayashi K","Takahashi T","Kimura N","Ito T","Shimizu H
OBJECTIVES:Although the patency of internal artery grafts in coronary artery bypass grafting (CABG) is superior to that of saphenous vein grafts (SVGs), good long-term patency rates have been reported with SVGs harvested using the no-touch technique. Here, we report the early results of CABG with no-touch SVGs (NT-SVGs) along with the precautions required while handling these grafts. METHODS:This retrospective study included 41 patients who underwent CABG with NT-SVGs between May 2016 and March 2018. NT-SVGs were harvested with minimal electric scalpel use, and post-harvesting vascular overdilation with a syringe was not performed. Blood with heparinized saline was used to prevent vascular endothelial damage. A drain was inserted into the SVG harvest site, which was closed with a single interrupted suture, and elasticated bandage and compression stockings were used to prevent fluid retention and avoid delayed wound healing. RESULTS:There was no case of postoperative thoracotomy due to bleeding or myocardial infarction, and postoperative graft assessment confirmed graft patency in all patients, with a little mismatch between the diameters of SVG and the anastomotic vessel. Delayed wound healing at the graft harvest site seemed to improve after introducing the above procedures. CONCLUSIONS:Early results of CABG with NT-SVGs were good. Some precautions must be taken during harvesting and anastomosis. Taking precautions described in this study may help reduce the risk of perioperative complications and make the no-touch technique the standard procedure for harvesting SVGs for CABG.
目的: 虽然在冠状动脉旁路移植术 (CABG) 中，内动脉移植物的通畅性优于隐静脉移植物 (SVGs)，但据报道，使用无接触技术获得SVGs的长期通畅率良好。在此，我们报告了使用无接触SVGs (nt-svgs) 的CABG的早期结果，以及处理这些移植物时所需的预防措施。 方法: 本回顾性研究包括2016年5月至2018年3月间接受CABG伴nt-svgs的41例患者。用最少的电刀使用收获NT-SVGs，并且不进行用注射器的收获后血管过度扩张。使用含有肝素化盐水的血液来预防血管内皮损伤。将引流管插入SVG收获部位，用单个中断的缝线将其封闭，并使用弹性绷带和加压长袜来防止液体潴留并避免伤口愈合延迟。 结果: 术后无一例因出血或心肌梗死而开胸，术后移植物评估证实所有患者移植物通畅，SVG直径与吻合血管略有不匹配。在引入上述程序后，移植物收获部位的延迟伤口愈合似乎有所改善。 结论: nt-svgs的CABG早期结果良好。在收获和吻合期间必须采取一些预防措施。采取本研究中描述的预防措施可能有助于降低围手术期并发症的风险，并使无接触技术成为CABG获取SVGs的标准程序。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.