Learning Curve for Using Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting

ZHANG Weihua; ZHANG Jian; SUN Xiaoke; LUO Hong; MA Ning; LIU Donghai; ZHANG Xin; QIAO Chenhui

doi:10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240305.009

您当前的位置：

首页 >

文章列表页 >

Learning Curve for Using Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting

Clinical Research | 更新时间：2024-04-15

- Learning Curve for Using Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 45, Issue 2, Pages: 319-323(2024)
- 作者机构：
  
  郑州大学第一附属医院心血管外科，河南郑州 450000
- 作者简介：
  
  ZHANG Jian； E-mail： zhangj122@foxmail.com
- 基金信息：
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240305.009
  CLC： R654.2
- Published：20 March 2024，
  
  Received：06 November 2023，
  
  Accepted：22 February 2024
扫描看全文
张伟华,张俭,孙晓柯等.经内窥镜大隐静脉获取术在冠状动脉旁路移植术中应用的学习曲线[J].中山大学学报（医学科学版）,2024,45(02):319-323.

ZHANG Weihua,ZHANG Jian,SUN Xiaoke,et al.Learning Curve for Using Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(02):319-323.
张伟华,张俭,孙晓柯等.经内窥镜大隐静脉获取术在冠状动脉旁路移植术中应用的学习曲线[J].中山大学学报（医学科学版）,2024,45(02):319-323. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240305.009.

ZHANG Weihua,ZHANG Jian,SUN Xiaoke,et al.Learning Curve for Using Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(02):319-323. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240305.009.

摘要

目的

探讨内窥镜获取大隐静脉在冠状动脉旁路移植术中的应用并探讨学习曲线，重点关注初学者易发生的问题及对早期临床结果的影响。

方法

回顾性分析2013年7月至2014年4月在郑州大学第一附属医院心外科接受不停跳冠状动脉旁路移植术并使用内窥镜技术获取大隐静脉的83例患者的临床资料，按照手术时间的先后顺序分为A组（初学组20例）、B组（熟悉组20例）、C组（进步组20例）、D组（成熟组23例），分析各组之间患者围术期及随访结果差异，明确学习曲线周期。

结果

该组患者年龄为（60.22±8.06）岁，体质量为（69.77±11.66） kg，其中合并高血压24例、糖尿病26例、亚急性脑梗14例。A组相对于后三组获取大隐静脉长度与时间比值明显较小（

0.001），静脉主干损伤数量明显较多（

=0.006），并且随访1年时静脉桥通畅率较低，但差异无统计学意义。

结论

内窥镜获取大隐静脉之前技术操作培训是必要的，能有效规避初学者造成的血管损伤，实际获取的过程中大概需要亲自操作20例，并认真总结技术技巧就可以较为熟练地进行相关操作。

Abstract

Objective

To investigate the application of endoscopy in obtaining the great saphenous vein （GSV） during coronary artery bypass grafting （CABG） and explore the learning curve， with a particular focus on common challenges encountered during the learning process and their impact on early clinical outcomes.

Methods

A retrospective analysis was conducted on clinical data from 83 patients who underwent off-pump CABG with endoscopic GSV harvesting at the First Affiliated Hospital of Zhengzhou University from July 2013 to April 2014. Patients were categorized into four groups based on the chronological order of their hospitalization： Group A （novice group，

=20）， Group B （proficient group，

=20）， Group C （progressive group，

=20）， and Group D （mature group，

=23）. Differences in perioperative and midterm follow-up outcomes among the groups were analyzed to determine the learning curve period.

Results

The study population had a mean age of （60.22±8.06） years and a mean body weight of （69.77±11.66） kg. Comorbidities included hypertension （24 cases）， diabetes （26 cases）， and subacute cerebral infarction （14 cases）. The novice group exhibited significantly shorter GSV length-to-harvest time ratio relative to the other three groups （

0.001） and a significantly higher incidence of main vein damage （

=0.006）. However， there was no statistically significant difference in graft patency at the 1-year follow-up.

Conclusion

Thorough and reliable technical training in endoscopic GSV harvesting is essential to minimize vascular injury caused by novice operators. Approximately 20 cases of hands-on experience and a careful self-analysis of procedural challenges are likely required to achieve proficiency in GSV harvesting.

关键词

冠状动脉旁路移植术内窥镜微创大隐静脉学习曲线

Keywords

coronary artery bypass graftingendoscopyminimally invasivegreat saphenous veinlearning curve

references

Gaudino M， Benedetto U， Fremes S， et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery［J］. N Engl J Med， 2018， 378（22）：2069-2077.

罗文琦，王子，王怀斌，等. 冠状动脉旁路移植术中桡动脉与大隐静脉用于右冠状动脉系统的通畅率比较研究［J］. 中国心血管病研究，2021，19（8）：722-725.

Luo WG， Wang Z， Wang HB， et al. The patency of radial artery and great saphenous vein bypassed to right coronary arterysystem in coronary artery bypass grafting-a propensity score matching analysis［J］. Chin J Cardiov Res， 2021， 19（8）： 722-725.

Zenati MA， Bhatt DL， Bakaeen FG， et al. Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass［J］. N Engl J Med， 2019， 380（2）：132-141.

王春元，胡展，张岩.桡动脉在冠状动脉旁路移植术中应用的研究进展［J］. 中国循环杂志，2023，38（4）：474-478.

Wang CY， Hu Z， Zhang Y. Progress on the use of radial artery for coronary artery bypass grafting［J］. Chin Circul J， 2023， 38（4）： 474-478.

Lumsden AB， 3rdEaves FF， Ofenloch JC， et al. Subcutaneous， video-assisted saphenous vein harvest： report of the first 30 cases［J］. Cardiovasc Surg， 1996， 4（6）：771-776.

Dacey LJ， Braxton JH， Kramer RS， et al. Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting［J］. Circulation， 2011，123（2）：147-153.

Zenati MA， Bhatt DL， Stock EM， et al. Intermediate-term outcomes of endoscopic or open vein harvesting for coronary artery bypass grafting： the REGROUP randomized clinical trial［J］. JAMA Network Open， 2021，4（3）：e211439.

Kim DY， Song H， Kim HW， et al. Early outcomes of endoscopic vein harvesting during the initial learning period［J］. Korean J Thorac Cardiovasc Surg. 2015， 48（3）：174-179.

3rdReed JF. Leg wound infections following greater saphenous vein harvesting： minimally invasive vein harvesting versus conventional vein harvesting［J］. Int J Low Extrem Wounds， 2008， 7（4）：210-219.

Yokoyama Y， Shimamura J， Takagi H， et al. Harvesting techniques of the saphenous vein graft for coronary artery bypass： insights from a network meta-analysis［J］. J Card Surg， 2021， 36（11）：4369-4375.

Kopjar T， Dashwood MR. Towards endoscopic no-touch saphenous vein graft harvesting in coronary bypass surgery［J］. Braz J Cardiovasc Surg， 2022， 37（Spec 1）：57-65.

Caliskan E， de Souza DR， Böning A， et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery［J］. Nat Rev Cardiol， 2020， 17（3）：155-169.

Nezafati MH， Nezafati P， Amoueian S， et al. Immunohistochemistry comparing endoscopic vein harvesting vs. open vein harvesting on saphenous vein endothelium［J］. J Cardiothorac Surg， 2014， 9：101.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Comparisons of the Learning Curve at the L4/5 and L5/S1 Level for Percutaneous Endoscopic Transforaminal Discectomy

Surgical Outcomes and Complications in 1 041 Patients Following Radical Cystectomy in a Single Center

Short-Term Efficacy of Two Different Access Site Ultrasound-Guided Radiofrequency Ablation for Saphenous Varicose Veins at Two Different Access Sites

Related Author

LIANG He-sheng

DENG De-li

CHEN Jin-xu

LIU Zhuo-wei

ZHOU Fang-jian

HAN Hui

YAO Kai

QIN Zi-ke

Related Institution

Department of Orthopedics， Central Hospital of Panyu District

Department of Urology， Sun Yat-sen University Cancer Center

Department of Vascular Surgery，The Third Affiliated Hospital，Sun Yat-senUniversity

Postal code：510080
Tel：020-87331643，87330827 Email：xbmed@mail.sysu.edu.cn
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰