Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts

ABSTRACT Objective: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft. Methods: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM). Results: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains. Conclusion: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions

Abstract The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.

Twenty-five years of no-touch saphenous vein harvesting for coronary artery bypass grafting: structural observations and impact on graft performance

Abstract The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.

Surgical aspects of no-touch saphenous vein graft harvesting in cabg: clinical and angiographic follow-up at 3 months

Abstract With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.

Medidas comportamentais de presença em ambientes virtuais / Behavioral measures of presence in virtual environments / Medidas conductuales de presencia en entornos virtuales

Para identificar e analisar as funções de respostas de interação com os estímulos de um ambiente virtual e suas relações com o grau de senso de presença relatado, utilizou-se o Xbox 360® com o jogo Kinect Adventures. Foram executadas quatro fases do jogo e feita aplicação de um questionário. As respostas verbais dirigidas aos estímulos virtuais não apresentaram um padrão comportamental, mas a frequência de respostas não verbais direcionadas a estímulos virtuais (RNV-EV) e o senso de presença aumentaram com o avanço nos estágios. Sugere-se que a frequência de RNV-EV é uma medida complementar apropriada do senso de presença e que fazer análises funcionais dos comportamentos emitidos durante a imersão pode ser uma forma útil de acessar o senso de presença.

To identify and analyze the functions of interactions responses to the stimuli of a virtual environment and their relation to the degree of reported presence of sense, the Xbox 360® with the Kinect Adventures game was used. Four phases of the game were executed and a questionnaire was administered. Verbal responses directed to virtual stimuli did not show a behavioral pattern, but the frequency of non-verbal responses directed to virtual stimuli (NVS-VS) and the sense of presence increased with the advance in stages. It is suggested that the frequency of VR-VS is an appropriate complementary measure of the sense of presence and perform functional analyzes of behavior during immersion can be useful to access the sense of presence.

Para identificar y analizar las funciones de las respuestas de interacción a los estímulos de un ambiente virtual y su relación con el grado de presencia relatado, se utilizó el Xbox 360® con el juego Kinect Adventures. Se llevaron a cabo cuatro fases del juego y un cuestionario. Las respuestas verbales dirigidas a los estímulos virtuales no mostraron un patrón de conducta, pero la frecuencia de respuestas no verbales dirigidas a los estímulos virtuales (RNV-EV) y la presencia aumentaron con el avance en etapas. Se sugiere que la frecuencia de RNV-EV es una medida complementaria apropiada de la presencia y que hacer análisis funcional de la conducta emitida durante la inmersión puede ser una forma útil para acceder al sentido de presencia.

Dacron graft intussusception technique for treatment of type a aortic dissections: technical notes and preliminary results

Abstract Introduction: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality. Objective: The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications. Methods: Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients. Results: Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively. Conclusion: This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.

Preparation of the saphenous vein for coronary artery bypass grafting: a new technique "no touch" that maintains the vein wall integral and provides high immediate patency

OBJETIVO: O objetivo deste trabalho é apresentar uma nova técnica "no touch" de preparo da veia safena e sua importância clínica. Esta nova técnica consiste na retirada da veia safena do seu leito, juntamente com um pedículo de tecido adiposo, protegendo a veia contra espasmos e, conseqüentemente, da necessidade de distendê-la durante a operação. MÉTODO: O estudo foi realizado em dois tempos: 1) Inicialmente, foi realizado um estudo prospectivo e randomizado, envolvendo 156 pacientes que foram submetidos à operação de revascularização miocárdica. Neste estudo nós comparamos a técnica "no touch" (NT) com duas outras: a convencional (C) e a intermediária (I). Foi feita uma avaliação detalhada da morfologia endotelial, utilizando a microscopia eletrônica, enquanto que a perviabilidade das pontes foi determinada com um exame angiográfico executado num período médio de 18 meses após a operação. 2) Finalmente, a enzima óxido nítrico síntase (NOS) foi identificada com ajuda do estudo imunohistoquímico e também pela localização auto-radiográfica de (3H)-L- Nitro-Arginina (NOARG). RESULTADOS: A avaliação morfológica mostrou integridade endotelial de 97 por cento nas veias que foram tratadas pela técnica NT; enquanto quase metade da superfície endotelial das veias tratadas pelas outras duas técnicas exibiu ausência de células endoteliais. O exame angiográfico revelou perviabilidade de 95,4 por cento para as pontes do grupo NT, 88,9 por cento para as pontes do grupo (C) e 86,2 por cento para as pontes do grupo (I). O estudo imunohistoquímico revelou a presença de NOS nas três camadas que compäem a parede da veia quando, as mesmas, foram tratadas pela técnica NT. Por outro lado, foi observada uma elevada redução desta enzima nas veias que foram tratadas pela técnica (C). A análise auto-radiográfica confirmou os resultados imunohistoquímicos. CONCLUSAO: A integridade endotelial e a atividade da enzima óxido nítrico síntase foram melhor mantidas com o uso da técnica NT no preparo da veia safena. A atividade vasodilatadora e bloqueadora da agregação plaquetária causada pelo óxido nítrico (NO) pode ser a responsável pela proteção da veia contra o espasmo, como também pela alta perviabilidade imediata da mesma. Além disso, as propriedades mecânicas providas pelo tecido gorduroso em volta da veia, contribuíram para o melhor resultado desta nova técnica.

Estudo morfométrico e estatístico da presença de pontes miocárdicas sobre o ramo interventricular anterior (descendente anterior) da artéria coronária esquerda em brasileiros / Morphometric and statistical study of myocardial bridges on anterior intraventricular branch (anterior descending) of the left coronary artery in Brazilians

Cinqüenta coraçöes humanos foram dissecados na regiäo da artéria interventricular anterior (IVA, nome clínico: descendente anterior). Foram feitas diversas medidas cardíacas (peso total, espessura das paredes livres ventriculares direita e esquerda), e medidas das "pontes" miocárdicas sobre a artéria IVA (profundidade máxima, comprimento, distância ao óstio coronário esquerdo). Na amostra aleatória de coraçöes estudados a incidência de "pontes" foi de 38%. Näo houve correlaçäo entre as várias medidas cardíacas, as "pontes" e a artéria IVA. Foram estatisticamente significativas somente as seguintes correlaçöes (p < 0,01): espessura do ventrículo esquerdo x profundidade da "ponte", e distância da "ponte" ao óstio coronário esquerdo x profundidade da das "pontes"; este índice pode ser um parâmetro na avaliaçäo clínica de "pontes" miocárdicas. Do ponto de vista anatômico a presença de "pontes", como um achado isolado, é uma variaçäo da sintopia da artéria IVA e do miocárdio ventricular