Endoscopic versus minimally invasive vein harvesting. Impact on leg-related morbidity in coronary artery bypass surgery: one-year follow-up of a prospective trial.

AIM: We sought to compare the impact of endoscopic and minimally invasive great saphenous vein harvesting on leg-related patient morbidity after coronary artery bypass grafting. METHODS: From February 2004 to July 2006, 120 patients underwent minimally invasive vein harvesting, and 180 patients underwent endoscopic vein harvesting for coronary artery bypass grafting. Patients were evaluated prospectively for wound-healing disturbances, residual leg edema, pain intensity and saphenous neuropathy at seven days, three months and one year after surgery. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, endoscopic vein harvesting was associated with a significantly lower incidence of residual edema (12% vs 28%, P<0.05 seven days postoperative; 6% vs 19%, P<0.001 three months postoperative), pain (9% vs 20%, P<0.05; 6% vs 10%, P<0.05) and saphenous neuropathy (6% vs 23%, P<0.001; 3% vs 14%, P<0.05) during follow-ups. Endoscopic vein harvesting was also associated with a significantly lower incidence of neurological disturbances at one-year follow-up (2% vs 8%, P<0.05). Mean harvesting time (43.9+/-10.2 vs 40.6+/-15.5 min, P=0.09), conversion rate (2% vs 3%, P=0.71) and injury per conduit (0.3+/-0.1 vs 0.3+/-0.2, P=0.91) were comparable for both groups. CONCLUSION: EVH is superior to MIVH in terms of reduction in pain intensity, residual leg edema and saphenous neuropathy at seven days and again at three months postoperative. A significantly lower incidence of neurological disturbances is still presented one year after surgery.

Postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting for coronary artery bypass grafting - a prospective analysis.

BACKGROUND: We sought to determine whether the postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting are comparable. METHODS: From February 2004 to September 2006, 120 patients underwent minimally invasive vein harvesting, and subsequently 150 patients had endoscopic vein harvesting for CABG. Patients were evaluated prospectively for wound-healing disturbances, residual leg oedema, pain intensity and saphenous neuropathy on the 7th postoperative day and after 3 months. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, minimally invasive vein harvesting was associated with a significantly higher incidence of residual oedema (28 % vs. 13 %; P < 0.05), (19 % vs. 6 %; P < 0.001), pain (20 % vs. 9 %; P < 0.05), (10 % vs. 6 %; P < 0.05), and saphenous neuropathy (23 % vs. 7 %; P < 0.001) (14 % vs. 3 %; P < 0.001) during follow-up on the 7th postoperative day as well as 3 months after surgery, respectively. Mean harvesting time (40.6 +/- 15.5 vs. 43.9 +/- 10.2 min; P = 0.09), conversion rate (3 % vs. 2 %; P = 0.71), and injury per conduit (0.3 +/- 0.2 vs. 0.3 +/- 0.1; P = 0.91) were comparable for both groups. CONCLUSIONS: Endoscopic vein harvesting seems to be superior to minimally invasive vein harvesting in terms of a significant reduction of residual leg oedema, pain intensity and particularly saphenous neuropathy in the postoperative and midterm follow-up.

[Endoscopic radial artery harvesting for coronary artery bypass grafting: first experience]. / Endoskopický odber arteria radialis pro revaskularizaci myokardu. Popis techniky a první zkusenost.

BACKGROUND: Radial artery is widely accepted for surgical myocardial revascularization due to reported better long-term patency than venous grafts. Endoscopic radial artery harvesting (ERAH) represents a modern method associated with reduction of post-harvesting complications in comparison with the traditional radial artery harvesting. METHODS: From October 2005 to March 2006, ERAH was performed in a group of 10 patients employing the Vasoview 6 system (Guidant, Europe S.A., Belgium). Patients were evaluated on 7th postoperative day for wound healing disturbances and neurological complications. RESULTS: The mean age was 62.7 +/- 11.3 years, male patients dominated (60%) and 5 patients (50%) suffered from diabetes. All 10 radial arteries were successfully harvested, no conduit was injured. No conversions were made from ERAH to traditional technique. The mean harvesting time was 44.9 +/- 8.2 min (range: 32-62) and the mean time of forearm ischemia was 56.7 +/- 9.3 min (range: 42-74). The mean length of the grafts was 20.3 +/- 2.2 cm. The small local haematoma was recorded in one patient (10%). Neither wound disturbances such as wound infection, wound dehiscence, skin necrosis, nor neurological complications were recorded in our group of patients. CONCLUSION: ERAH is a safe method associated with a significant reduction of particularly neurological complications associated with traditional radial artery harvest. Full-length radial artery conduits were obtained with improved cosmetic result and patient's satisfaction.

[Endoscopic saphenous vein harvesting for coronary artery bypass grafting]. / Endoskopický odber vena safena magna pro revaskularizaci myokardu.

BACKGROUND: Traditional great saphenous vein harvest for coronary artery bypass grafting is associated with a significant risk of impaired wound healing. Endoscopic saphenous vein harvesting (EVH) has been introduced in an effort to reduce the incidence of leg-wound complications, whereas the histological quality and long-term patency of harvested grafts are comparable with grafts harvested by means of traditional technique. METHODS: From July to December 2005, EVH was performed in a group of 60 patients employing the Vasoview 6 system (Guidant, Europe S.A., Belgium). Patients were evaluated on 7th postoperative day for wound healing disturbances, residual leg oedema and saphenous neuropathy. RESULTS: The mean age was 67.4 +/- 11.2 years, male patients dominated (68%). At least one independent risk factor of leg-wound disturbances such as obesity, diabetes, peripheral vascular disease and female gender, was presented in 39 patients (63%). The mean number of harvested venous grafts was 2.0 +/- 1.2 and the mean total vein harvesting time was 46.2 +/- 7.4. In one case (1.7%), EVH was converted to the traditional harvesting technique due to superficial course of the great saphenous vein. The presence of wound haematoma was noted in 31 patients (51%). No other wound disturbances such as wound infection, wound dehiscence, skin necrosis, lymphatic wound drainage, nor saphenous neuropathy were recorded in the group of patients. The leg oedema associated with EVH was presented in 7 patients (12%). CONCLUSIONS: EVH is a safe method associated with a significant reduction of leg-wound complications, residual leg oedema and saphenous neuropathy. EVH should become method of choice, particularly in the presence of independent risk factors of leg-wound disturbances. The quality and the harvesting time of harvested grafts were comparable to grafts harvested by means of the traditional harvesting technique.

Comparison between blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary surgery.

This study was done to compare the protective effect of blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Sixty consecutive patients with left ventricular ejection fraction < 35% scheduled for CABG with the use of cardiopulmonary bypass without additional procedures were randomly divided into two groups. In the first group we used cold blood cardioplegia, in the second group cold crystalloid cardioplegia, both delivered only ortogradely. We measured hemodynamic data in early hours after operation, enzyme release and we collected other clinical data which could be influenced by perioperative myocardial protection. There was no death in either group. We also didn't find any significant difference in incidence of perioperative myocardial infarction, arrhythmias and use of intraaortic balloon pumping between both groups. In an early hours after operation in the group with blood cardioplegia we found significantly better hemodynamic data (LVSWI, RVSWI) and significantly lower enzyme release. We conclude, that cold blood cardioplegia shows superior perioperative myocardial protection resulting in earlier restoration of myocardial function. This difference could be important in patients with high degree of left ventricular dysfunction.

[Ureteroureteral end-to-side anastomosis in kidney transplantation--personal experience]. / Uretero-uretero anastomóza end to side u transplantací ledvin--nase zkusenosti.

The most widely used way of reconstruction of the urinary pathways in transplantations of the kidney is at present a ureteroneocysto anastomosis. In some patients this type of reconstruction is difficult, if not impossible (adhesions in the lesser pelvis of the recipient, atrophic urinary bladder, short ureter of the graft, transplantation of child kidneys). In these instances the authors indicated a uretero-uretero end-to-side anastomosis. The authors performed in 13 patients a total of 17 uretero-uretero end-to-side anastomoses. In six transplantation of child kidneys en bloc was involved. During the postoperative period one female patient developed a urinary fistula from the renal pelvis of the graft which healed after conservative treatment. End-to-side uretero-uretero anastomosis is a simple and safe way of reconstruction of the urinary pathways in renal transplantations.

[Effect of long-term administration of haloperidol: ultrastructural changes in the prefrontal cortex]. / Deistvie galoperidola pri dlite'lnom vvedenii: u'ltrastrukturnye perestroiki v prefronta'lnoi kore.

Haloperidol, when injected regularly during 3 weeks at a dose of 0.1 mg/kg, influenced glial cells and neuropile. The conditions of the glial cells suggested their increased metabolism. Morphometry revealed increased density of axodendritic synapses and reduced density of axospinal synapses at the spinal collumin the IV layer of medial prefrontal cortex. Virtually all the parameters measured in axodendritic synapses were decreased (presynaptic terminal area, mytochondrial total area and their count in the presynaptic terminal, the length of postsynaptic dense area). The data indicate that ultrastructural changes resulted from decrease of efficiency of synaptic transmission which occurred in several synapses as a result of haloperidol induced receptor block.